Wrist pain, bone mets

[painfree23]

64 year old patient with bone Mets (breast primary) only to wrist , failed radiation. Her wrist has ROM painful, has a palpable 2-3 inch mass. She wants a “nerve block”. Any ideas?

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[Ducttape]

doesnt sound like a clearly defined neve distribution...

i remember reading a paper about combined radial and ulnar nerve blocks at the elbow.

or you could try a stellate.

 

[painfree23]

doesnt sound like a clearly defined neve distribution...

i remember reading a paper about combined radial and ulnar nerve blocks at the elbow.

or you could try a stellate.

Hm. Radial and ulnar at the elbow. Just 0.25% bupi? I’m sure motor function will be an issue?

 

[BobBarker]

Stick an osteocool probe in it?

 

[swamprat]

How about dexamethasone PO?

 

[GoBeers]

do most of you manage cancer pain or do you defer to oncologist/palliative care?

 

[Orin]

Stick an osteocool probe in it?

Yeah, this is the right answer if it is in the bone as that system is FDA approved for bone anywhere. Can you show me an image?

The nerve stuff is hard as you would have to figure out what osteotome you're working with, and there's some variability in which text you read on this. You could do selective blocks in the proximal forearm to figure it out and then target things depending on response.

Regional Anaesthesia for Awake Hand Surgery: Block Failure and Troubleshooting Issues

Regional Anaesthesia for Awake Hand Surgery: Block Failure and Troubleshooting Issues : WFSA - Resources |

resources.wfsahq.org

I've also had good luck with slapping a Flector patch over things for bone mets, but if you get a good MRI/CT scan pic and feel comfortable with the approach, you can consider doing the bone RFA yourself or sending it to an interventional radiologist or "interventional oncologist" as they market themselves as sometimes. The bone RFA is nice as it could provide local disease cure and pain management.