Transforming pain relief: intercostal nerve blocks for intractable pain due to metastatic cancer of the ribs

Pain is a prevalent symptom in advanced cancer, with 66.4% of patients experiencing moderate to severe pain. Effective management is challenging, as up to 80% of the patients report severe pain, making optimal quality of life a critical goal. A 23-year-old woman, with rectal cancer, suffered intractable left chest pain due to rib metastasis, worsening over a year. Despite treatment with fentanyl with patient-controlled analgesia (PCA) and oral morphine, the patient experienced intractable cancer pain, requiring 53 attempts at fentanyl PCA administration, with a total of 1 g used within 24 hours during the most severe episodes, when her pain score reached 9-10. An ultrasound-guided intercostal nerve block was performed at levels 7 and 10, using 20 mg triamcinolone and 10 mL of 0.75% ropivacaine. Post-procedure, the patient reported localized pain at the injection site, but experienced a significant reduction in sharp chest pain. This intervention resulted in an 80% decrease in her background opioid usage and reduced the frequency of as-needed doses. This case underscores the effectiveness of interventional pain management techniques, such as nerve blocks, as alternatives or adjunct treatment, when conventional medications fail. The combination of local anesthetics for immediate relief and steroids for long-term benefits, can effectively minimize opioid dependence and side effects. Abbreviations: ICNB: intercostal nerve block, NRS: Numeric Rating Scale, PCA: patient-controlled analgesia, Keywords: Cancer Pain; Chronic Pain; Patient-Controlled Analgesia; Intercostal Nerve Block; Interventional Pain Citation: Wibowo CR, Putri HS, Susila D. Transforming pain relief: intercostal nerve blocks for intractable pain due to metastatic cancer of the ribs. Anaesth. pain intensive care 2024;28(5):127-131. DOI:10.35975/apic.v29i1.2652 Received: November 01, 2024; Reviewed: December 20, 2024; Accepted: December 23, 2024