Serratus anterior plane block for severe neuropathic pain management in locally advanced non-small cell lung cancer: a case report

Abstract

Background: The serratus anterior plane block (SAPB) provides analgesia to the anterolateral chest wall. While its use has expanded in thoracic and breast surgery, data on its application for neuropathic cancer pain remain limited. This case illustrates continuous SAPB as a viable alternative when neuraxial and paravertebral approaches are contraindicated. Case Description: A 67-year-old man with locally advanced non-small cell lung cancer (NSCLC) involving the right middle and lower lobes presented with severe neuropathic thoracic pain. Magnetic resonance imaging demonstrated spine invasion with paravertebral extension at T6-T7 level. Pain persisted despite multimodal therapy, including high-dose opioids, causing somnolence. Distorted spinal anatomy and therapeutic anticoagulation contraindicated epidural and paravertebral blocks. An ultrasound-guided continuous SAPB using ropivacaine plus dexamethasone was administered, resulting in immediate pain relief, improved respiratory effort, and a reduction in daily opioid requirements. Analgesia was maintained for seven days until surgical intervention. The patient underwent an extensive en bloc resection and spinal fusion, all of which were completed successfully. However, during the postoperative course, the patient developed respiratory failure with sepsis, culminating in patient death on postoperative Day 8. Conclusions: Continuous SAPB provided effective, opioid-sparing analgesia for severe neuropathic chest wall pain secondary to advanced lung cancer. Given its technical simplicity, favourable safety profile, and efficacy in the setting of distorted spinal anatomy and contraindications to neuraxial or paravertebral techniques, the SAPB represents a valuable option for managing complex thoracic cancer-related pain.