Epidural Alcohol Neurolysis–A Good Option for Cancer Pain Management in Developing Countries

The site for placement of the epidural catheter was selected based on the underlying pathology as well as on each patients description of the pain dermatome. All patients were having pain between T1-T12 dermatome level. Epidural was performed either sitting or lateral position depending on patient comfort. Under aseptic precautions skin of epidural site was anaesthetized with 1% Xylocaine. A 20 G catheter was placed 3-5 cm within the epidural space at level of T5-T6 level using an 18 G Touhy needle using loss of resistance technique. Correct placement of catheter was tested by complete pain relief with 5 ml of 0.125% Bupivacaine injection and aspiration for CSF and blood. The epidural catheter was taped securely in place. Epidural injection of 5 ml of 50% Alcohol was done slowly 4 hours after LA injection test. The patient was positioned 30° Head up with supine for visceral or bilateral somatic pain or Lateral on affected side up for unilateral pain as alcohol is bit hypobaric in nature. 12 After injection catheter was flushed with1 ml of 0.125 % bupivacaine. Second and third epidural alcohol injections were made in a daily basis until the patient experienced 75% pain relief persistent over 24 hours and decrease in narcotic use of at least 25%. Patients were asked about any tingling, numbness, sensory loss, motor weakness, bladder and bowel dysfunction. The position of patient, precautions and techniques were kept similar on all 3 days. The intravenous hydration was only instituted in cases where patients experienced nausea vomiting, diarrhoea or hypotension. Heart Rate, Blood Pressure and Spo2 monitoring were utilized during each injection. Catheter was removed at least one hour following final injection of alcohol. Following the procedure, patients could receive medications according to a modified analgesic regimen based on World Health Organization guidelines [4]. The patients were discharged 24 hrs after catheter removal.