PERCUTANEOUS CERVICAL CORDOTOMY AND SUBARACHNOID PHENOL BLOCK USING FLUOROSCOPY IN PAIN CONTROL OF COSTOPLEURAL SYNDROME

We examined the efficacy of percutaneous cervical cordotomy (PCC) and subarachnoid phenol block using fluoroscopy (SAPB-F) for control of ch est and/or back pain from costopleural syndrome. The efficacy of each block was evaluated by changes in pain score (PS), analgesic dose and performance status 1 week after the block, as well as by the complicat ions. Between 1980 and 1986, PCC was performed in 10 patients. SAPB-F was performed in 13 patients between 1987 and 1991. Pain was not well controlled by analgesics in any of these patients. For PCC the follow- up period was 94.7 +/- 71.1 days. PS (VAS, 0-10) reduced from 8.5 +/- 0.9 to 3.0 +/- 2.7. No analgesics were needed in 4 patients. Pain recu rred in 1 patient. Hemiparesis occurred in 2 patients. General fatigue occurred in 6 patients. In 4 patients with these complications perfor mance status deteriorated and did not recover during the follow-up per iod. For SAPB-F the follow-up period was 71.8 +/- 44.0 days. SAPB-F wa s designed to achieve selective phenol deposit at the targeted nerve r oot. PS decreased from 7.5 +/- 1.9 to 2.7 +/- 2.6. No analgesics were needed in 5 patients. Pain recurred in 3 patients. There were no compl ications and no changes in performance status. From this study we conc luded that PCC is an effective method of pain control for costopleural syndrome, but a risk of serious complications is involved. SAPB-F is an effective and safe method and should be the first choice of nocicep tive pathway block.