BACKGROUND AND OBJECTIVES: Pleural phenol was used successfully to alleviate terminal pain associated with metastatic esophageal cancer in a 43-year-old man. METHODS: The patient first was given 20 ml 0.5% bupivacaine for diagnostic purposes through an interpleural catheter to control a severe aching pain throughout the T5-8 dermatomes. Seven days later, 10 ml 6% phenol suspended in 0.5% bupivacaine was injected and produced analgesia for two days. A second injection using 18 ml 10% phenol provided adequate analgesia for the next four weeks until the patient's death. Two weeks after the lower thoracic pain was relieved, the patient had complained of a new right-sided pain in the region of C7-T2, which was treated successfully with 10 ml 10% phenol. RESULTS: During the course of this therapy, his sustained-release morphine consumption diminished from 540 mg to 90 mg despite his terminal disease. Post mortem examination and histologic studies revealed no macroscopic or microscopic changes to the viscera, spinal cord, or sympathetic chain. CONCLUSIONS: Repeated doses of phenol suspended in bupivacaine provide adequate analgesia for terminal cancer pain when administered interpleurally. No pathologic changes were detected despite a total of 3400 mg phenol delivered into the right thoracic cavity.
BACKGROUND AND OBJECTIVES: Pleural phenol was used successfully to alleviate terminal pain associated with metastatic esophageal cancer in a 43-year-old man. METHODS: The patient first was given 20 ml 0.5% bupivacaine for diagnostic purposes through an interpleural catheter to control a severe aching pain throughout the T5-8 dermatomes. Seven days later, 10 ml 6% phenol suspended in 0.5% bupivacaine was injected and produced analgesia for two days. A second injection using 18 ml 10% phenol provided adequate analgesia for the next four weeks until the patient's death. Two weeks after the lower thoracic pain was relieved, the patient had complained of a new right-sided pain in the region of C7-T2, which was treated successfully with 10 ml 10% phenol. RESULTS: During the course of this therapy, his sustained-release morphine consumption diminished from 540 mg to 90 mg despite his terminal disease. Post mortem examination and histologic studies revealed no macroscopic or microscopic changes to the viscera, spinal cord, or sympathetic chain. CONCLUSIONS: Repeated doses of phenol suspended in bupivacaine provide adequate analgesia for terminal cancer pain when administered interpleurally. No pathologic changes were detected despite a total of 3400 mg phenol delivered into the right thoracic cavity.