Bilevel opposite direction ESP block with indwelling catheter in the management of severe lung cancer pain.

One of the biggest challenges faced by pain physicians is that cancer patients present with unrelieved pain despite multimodal drug regimes. Regional anesthesia methods and indwelling catheters become significant when pain control cannot be achieved with these regimens. Ultrasound-guided erector spinae plane (ESP) block has provided analgesia for acute postoperative and chronic cancer pain. This is a case of a 58-year-old male with no significant medical history prior to being diagnosed with lung cancer two years ago who is having severe pain in the entire hemithorax after the diagnosis. ESP block with the indwelling catheter was administered at two different levels in opposite directions, one from the T5 level in the caudal-cranial direction and one from the T7 in the cranial-caudal direction, provide adequate analgesia between T2-T12 dermatomes. Bilevel opposite direction ESP block with an indwelling catheter may result in better analgesia in oncologic patients where pain control cannot be achieved with opioids.