Ultrasound-Guided Erector Spinae Plane Block for Intractable Thoracic Cancer Pain: A Case Series of Five Patients

Abstract

Thoracic cancer pain, particularly due to lung malignancies, chest wall infiltration, or pancoast tumors, is often severe and multifactorial. When conventional systemic analgesics alone are inadequate, ultrasound-guided fascial plane blocks, such as the erector spinae plane block (ESPB), may provide rapid significant pain relief, particularly in outpatient settings. We report five cases of advanced thoracic malignancies with severe, refractory pain (Numerical Rating Scale [NRS] 8–10) despite optimized systemic analgesics. ESPB was performed using an in-plane ultrasound-guided technique at levels T4–T8 with a combination of local anesthetic and corticosteroid. All patients achieved significant pain relief (≥5-point reduction in NRS) and improved mobility immediately post-injection, with sustained pain control on reduced oral analgesic doses. During follow-up, one patient required a repeat block after one month, three maintained satisfactory analgesia with oral medications, and one patient was lost to follow-up. No procedural complications were observed. The erector spinae plane block appears to be a technically simple and effective regional analgesic technique for managing intractable thoracic cancer pain. Its rapid onset, opioid-sparing potential, and favorable safety profile make it a valuable adjunct in the palliative care of patients with advanced thoracic malignancy. Larger prospective studies are warranted to define optimal protocols and long-term efficacy.