Utilization of ultrasound to confirm lesions and perform paravertebral blocks for painful pleural metastasis treatment – A report of two cases

Year 2025, Volume: 42 Issue: 2, 222 - 225, 30.06.2025

Jae Hwan Kim Daeseok Oh , Sung Ho Moon Myoung Jin Ko Yei Heum Park Byeongcheol Lee Jiyeon Kwon

Abstract

Pleural metastasis-related pain poses a significant challenge in patients with cancer, often leading to severe discomfort and impaired quality of life. Thoracic paravertebral block is an effective regional anesthesia technique for managing such pain, particularly when performed under ultrasound guidance. This report illustrates the use of ultrasound for identifying metastatic lesions and guiding thoracic paravertebral block in two patients with pleural metastasis. The first case involved a 76-year-old woman with severe left upper back pain secondary to lung cancer metastasis. Ultrasound confirmed the presence of a lesion at the T5 level, and ultrasound-guided thoracic paravertebral block provided immediate and substantial pain relief, thereby improving sleep quality. The second patient was a 72-year-old man with intractable left upper back pain. Ultrasonography revealed a metastatic lesion at T6, and subsequent thoracic paravertebral block led to significant pain reduction and improved pain management with reduced opioid use. Both cases highlight the effectiveness of ultrasound in accurately locating metastatic lesions and determining the appropriate spinal level for thoracic paravertebral block, resulting in significant pain relief and improved quality of life. These findings underscore the importance of precise anatomical localization and the potential of ultrasound-guided thoracic paravertebral block as a valuable tool for managing pain associated with pleural metastases.

Keywords

ultrasonography , thoracic paravertebral block , pleural neoplasms , intractable pain

Ethical Statement

This study was approved by the institutional review boards of the Inje University Haeundae Paik Hospital, Republic of Korea; a waiver of consent was obtained (Number: HP IRB 2024-05-040 Date: 2024.5.31).

Supporting Institution

Inje University Haeundae Paik Hospital

Thanks

None

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