Four cancer patients with prior bladder diversions had phenol neurolytic saddle blocks performed for intractable pelvi-sacral pain. All patients had advanced disease, the focus of their treatment being palliative. Treatment limiting side effects precluded further upward titration of systemic analgesic therapies. Pain control improved after intrathecal neurolysis and allowed a greater than 60 percent reduction in systemic opiate dosage. No significant block-related adverse effects were encountered. The value and technical aspects of intrathecal saddle blocks in end-of-life pain management is discussed.
Swerdlow M: Neurolytic blocks of the neuraxis. In Patt, RB (ed.), Cancer Pain. Philadelphia: J.B. Lippincott, 1993, 4427-4442.
2.
Ischia S, Luzzani A, Ischia A, et al.: Subarachnoid neurolytic block (L5-S1) and unilateral percutranous cordotomy in the treatment of pain secondary to pelvic malignancy. Pain. 1984; 20: 139-149.
3.
Plancarte R, Velazquez R, Patt RB: Neurolytic blocks of the sympathetic axis. In Patt RB (ed.), Cancer Pain. Philadelphia: J.B. Lippincott, 1993: 377-425.
4.
Simon DL, Carron H, Rowlinson JC: Treatment of bladder pain with transsacral nerve block. Anesth Analg. 1982; 61: 46-48.
5.
Robertson DH: Transsacral neurolytic block. An alternative approach to intractable perineal pain. Br J Anaesth. 1983; 55: 873-875.
6.
Wilson F: Neurolytic and other locally-acting drugs in the management of pain. Pharmacol Ther. 1981; 12(3): 599-611.
7.
Maher RH: Neurone selection in relief of pain. Further experiences with intrathecal injections. Lancet. 1957; i: 16-19.
8.
Lipton S: Neurolysis. Pharmacology and drug selection. In Patt RB (ed.) Cancer Pain. Philadelphia: J.B. Lippincott, 1993: 343-358.
Maher RM, Mehta M: Spinal (intrathecal) and extradural analgesia. In Lipton S (ed.), Persistent pain: Modern methods of treatment (vol. 1). New York: Grune & Stratton, 1977: 61-100.
11.
Lifshitz S, Debacker LJ, Buchsbaum HJ: Subarachnoid phenol block for pain relief in gynecologic malignancy. Obstet Gynecol. 1976; 48(3): 316-320.
12.
Stovner J, Endresen R: Intrathecal phenol for cancer pain. Acta Anaesthesiol Scand. 1972; 16(1): 17-21.
13.
Arbit E: Neurosurgical management of cancer pain. In Foley KM (ed.), Advances in Pain Research and Therapy (vol. 16). New York: Raven Press, 1990: 289-300.
14.
Ischia S: Lytic saddle block. Clinical comparison of the results using phenol at 5, 10, and 15 percent. In al CBe (ed.), Advances in Pain Research and Therapy (vol. 7). New York: Raven Press, 1984: 339-341.
15.
Maher RH: Relief of pain in incurable cancer. Lancet. 1955; i: 18-20.
16.
Ichiyanagi K, Matsuki M, Kinefuchi S, et al.: Progressive changes in the concentrations of phenol and glycerine in the human subarachnoid space. Anesthesiology. 1975; 42(5): 622-624.
