Intermittent Erector Spinae Plane Block Via Subcutaneous Port for Cancer Pain

Cancer-related pain in patients with lung cancer is often multifactorial and may be difficult to control using conventional systemic analgesic therapies alone. Regional anesthesia techniques have increasingly been explored as adjunctive approaches to improve pain control while minimizing systemic opioid exposure.

The erector spinae plane (ESP) block is a fascial plane block in which local anesthetic is injected adjacent to the erector spinae muscle, allowing spread to the dorsal and ventral rami of spinal nerves. This technique has been reported to provide effective analgesia for thoracic and chest wall pain with a favorable safety profile.

In this study, patients with lung cancer experiencing moderate to severe cancer-related pain will receive intermittent ESP block administered through a subcutaneous port. The port system allows repeated administration of local anesthetic without the need for repeated needle insertion, potentially improving patient comfort and feasibility of long-term pain management.

Pain intensity will be assessed using standardized pain assessment tools at predefined time points. Additional outcomes include changes in analgesic medication requirements, patient-reported comfort, and the occurrence of procedure-related or treatment-related adverse events.

This study is designed to evaluate the feasibility, effectiveness, and safety of intermittent ESP block via a subcutaneous port as part of a multimodal pain management strategy in patients with lung cancer.

Inclusion criteria

• Adult patients diagnosed with advanced-stage lung cancer who are currently receiving palliative care only.
• Presence of chronic cancer-related chest pain lasting longer than 1 month, localized to the thoracic region due to chest wall invasion, pleural involvement, or bone metastases.
• Performance status ≤ 3 according to the Eastern Cooperative Oncology Group (ECOG), allowing placement of a subcutaneous port and maintenance of local anesthetic administration.
• Inadequate pain control with conventional analgesic therapies or clinical indication for the addition of regional analgesia.
• Ability to understand the study procedures and provide written informed consent after receiving a full explanation of the intervention.

Exclusion criteria

• Chest pain with radiation to the upper extremities, neck, or shoulder, suggestive of non-localized thoracic pain.
• Severe hepatic or renal dysfunction, or severe heart failure (New York Heart Association class III-IV).
• Local infection at the injection or port placement site, or uncontrolled systemic infection.
• Severe cachexia or insufficient subcutaneous tissue that does not allow safe coverage of the subcutaneous port.
• Known allergy to amide-type local anesthetics or other contraindications to regional anesthesia.
• Severe cognitive impairment, altered consciousness, or inability to cooperate with post-intervention monitoring.
• Lack of adequate caregiver support for home-based follow-up after discharge or inability to coordinate follow-up with local healthcare facilities.
• Severe coagulation disorders, defined as:

• International normalized ratio (INR) > 1.5
• Activated partial thromboplastin time (aPTT) > 40 seconds
• Fibrinogen < 1.5 g/L
• Platelet count < 50 × 10⁹/L.