Alleviating Refractory Abdominal Pain in Cholangiocarcinoma Using Erector Spinae Plane Block in the Emergency Department

J Emerg Med. 2022 Mar;62(3):393-396. doi: 10.1016/j.jemermed.2021.11.012. Epub 2022 Jan 20.

Abstract

Background: Acute pain management in the emergency department (ED) is a challenging task, more so in pain due to malignancy. Opioids have life-threatening side effects in ED patients, along with the risk of dependency. Erector spinae plane block (ESPB) is a recently described plane block technique with ease of performance and minimal side effects, making it suitable for emergency settings.

Case report: A 62-year-old male patient recently diagnosed with cholangiocarcinoma presented to the ED with severe right upper abdominal pain. There was no pain relief with high doses of analgesics. ESPB was administered at T7 vertebrae level. The patient's Defense and Veteran Pain Rating Scale score reduced from 8/10 pre-procedure to 3/10 within 15 min, and 2/10 1 h after the procedure. He reported that he had an uninterrupted pain-free sleep after 4 days. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ESPB is a novel regional analgesia that may help in management of uncontrolled severe pain not relieved with analgesics in patients with cholangiocarcinoma in the ED.

Keywords: cholangiocarcinoma; emergency department; erector spinae plane block.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / etiology
  • Bile Duct Neoplasms* / complications
  • Bile Ducts, Intrahepatic
  • Cholangiocarcinoma* / complications
  • Emergency Service, Hospital
  • Humans
  • Male
  • Middle Aged
  • Nerve Block* / methods
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / etiology