Continuous epidural analgesia and interscalene brachial plexus block as postoperative analgesia for Pancoast tumor resection: a case report

Pancoast tumor resection is associated with severe postoperative pain. In addition to wound pain, patients often complain of shoulder and upper extremity pain due to brachial plexus damage, making pain management difficult. We attempted to perform a continuous brachial plexus block in addition to continuous epidural analgesia. For a 58-year-old man, left upper lobectomy and chest wall resection around the pulmonary apex was planned for the left Pancoast tumor. In this case, the appearance of neuropathic pain in the shoulder and upper extremity due to the effects of brachial plexus injury associated with the surgical operation was expected. General anesthesia was introduced after insertion of the epidural catheter, followed by insertion of a catheter for brachial plexus block (interscalene approach) under dual guidance of ultrasound device and nerve stimulator. For continuous epidural analgesia, a combination of 0.15% ropivacaine and fentanyl (8 µg/h) was administered at 4 mL/h. For continuous brachial plexus block, 0.15% ropivacaine was administered at 3 mL/h for 7 days. Postoperative analgesia was maintained at a Numerical Rating Scale of 2-3 for shoulder pain and 0-1 for wound pain. Satisfactory postoperative analgesia for Pancoast tumor resection was achieved with continuous epidural analgesia and continuous brachial plexus block.