Clinical Practice and Cases in Emergency Medicine

Introduction: Breakthrough pain is frequently experienced by patients with gastrointestinal malignancies and is a common reason for presenting to the emergency department (ED). After ruling out acute pathology, ED management typically consists of intravenous opioids, though high doses of opioids can be associated with potentially severe adverse events and complications in certain high-risk populations. Regional anesthesia strategies, such as the erector spinae plane block (ESPB), have shown to be effective for several etiologies of non-malignant visceral abdominal pain. This case series sought to evaluate whether the ESPB can be effective for ED patients with breakthrough pancreatic and hepatobiliary cancer pain. 

Case Report: Three patients with breakthrough hepatopancreatobiliary cancer pain underwent successful ESPBs performed by an emergency medicine physician in the ED. All patients reported considerable reduction in their pain. Two patients with cancer of the pancreatic head reported complete pain relief and were able to be discharged from the ED. The third patient with metastatic colorectal cancer involving the hepatobiliary system was admitted for further medical work-up, though did not require any additional analgesics for nearly 13 hours after the block. 

Conclusions: The ESPB appears to be a safe and effective strategy for managing breakthrough pain related to pancreatic and hepatobiliary malignancy in the ED.