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Erector spinae plane block for acute pain management of pancreatic cancer at the emergency department

Abstract

Pancreatic cancer is often associated with intractable pain due to tumor invasion of surrounding neural structures and visceral organs. Conventional pain management strategies, including opioids, are often insufficient and associated with significant side effects.

The erector spinae plane block (ESPB) is an inter-fascial regional anesthesia technique that can be considered in managing abdominal pain. Besides being a simple block performed, ESPB is also very effective because it provides visceral, somatic and neuropathic pain coverage.

This case series highlights the potential role of ESPB as an adjunctive therapy for acute pain management of pancreatic cancer patients at the emergency department, with discussion on its technical aspect, advantages and limitations.

Introduction

Pancreatic cancer is the seventh leading cause of cancer death worldwide with a 5-year survival rate of less than 10% [1]. Pain is present in 70-80% of the pancreatic cancer patients at presentation, due to tumor invasion of surrounding structures, neural plexus and visceral organs [2]. Pain is often severe, localized to the epigastrium, and radiates to the back, significantly impairing quality of life.

Conventional pain relief for pancreatic cancer is usually opioid based medications which are prescribed in up to 75% of the patients [3]. However, strong opioids are associated with side effects such as constipation, sedation, nausea and vomiting. Besides, patients with chronic usage of opioid develop tolerance leading to less effect and higher usage. Hyperalgesia may also occur with increased dosage of opioids causing worsening of pain instead of relief [4].

The erector spinae plane block (ESPB) is an inter-fascial plane block that was first described by Forero in 2016 using ultrasound guidance for thoracic neuropathic pain [5]. Subsequently, ESPB has gained widespread use in many types of pain including pancreatic cancer pain [6, 7]. A single shot of ESPB can decrease opioid consumption for up to 24 h [8]. ESPB is relatively easy to perform under ultrasound guidance and has a favorable safety profile [9].

ESPB has been recognized as one of the Plan A blocks, a set of basic regional blocks that can be performed by non-experts [10]. Access block had become a major healthcare problem globally and resulted in patients staying long hours at the emergency department [11]. ESPB can be performed by emergency physicians to relief acute pain of terminally ill pancreatic patients while waiting for admission to the palliative ward. This case series explores the use of ESPB in four pancreatic cancer patients who had refractory pain at the emergency department.

Conclusion

ESPB can be part of the multimodal approach in managing pancreatic cancer pain at the emergency department. Preliminary findings from this case series suggest that ESPB can decrease opioid usage. Further prospective or controlled studies are needed to validate these findings and the efficacy of ESPB in pancreatic malignancy.

READ MORE HERE: https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-025-00461-1

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