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Case Report Volume 18 Issue 3
Combined ultrasound-guided neurolysis of PECS planes I–II and interscalene block with phenol for the treatment of cancer pain in a palliative patient secondary to advanced metastatic breast cancer: case report
Dr. Cristopher Garcia Quintero, Dr. Tania Libertad Gonzalez, Dr. Guillermo Artechiga Ornelas, Dr. Jorge Bonilla Flores, Dr. Lourdes Marlene Zuñiga, Dr. Patrick Pendavis Hecksner
Received: July 01, 2026 | Published: July 28, 2026
Citation: Quintero CG, Gonzalez TL, Ornelas GA,et al. Combined ultrasound-guided neurolysis of PECS planes I–II and interscalene block with phenol for the treatment of cancer pain in a palliative patient secondary to advanced metastatic breast cancer: case report. J Anesth Crit Care Open Acce. 2026;18(3):64-67. DOI: 10.15406/jaccoa.2026.18.00654
Abstract
Cancer pain associated with advanced breast cancer presents a complex therapeutic challenge
due to the coexistence of somatic, neuropathic, and structural mechanisms resulting from
tumor progression, surgical sequelae, and complications of systemic treatment. Although
pectoral plane blocks (PECS I and PECS II) and inescalametic nerve blocks are widely used
in perioperative analgesia, published experience regarding their use as a route for chemical
neurolysis in patients with refractory cancer pain remains limited.
Case presentation: We present the case of a 39-year-old woman diagnosed with triple-
positive invasive ductal carcinoma of the left breast, with pulmonary, bone, and chest
wall metastases. She had received neoadjuvant chemotherapy, left radical mastectomy,
and adjuvant systemic therapy. During her follow-up, she developed extensive tumor
infiltration of the chest wall and left axillary region, post-mastectomy pain syndrome,
neuropathy secondary to vinorelbine, ipsilateral lymphedema, and bilateral pathological
fractures of the humerus treated with intramedullary nail fixation. Despite multimodal
pharmacological treatment, including oral morphine 30 mg every 6 hours, severe mixed
pain persisted with an intensity of 10/10 on the Visual Analogue Scale (VAS), associated
with significant functional impairment. Ultrasound-guided chemical neurolysis of PECS I
and PECS II planes was performed using 3% phenol (5 mL in each plane), complemented
by ultrasound-guided interscalene block using 0.375% ropivacaine and 1 mL of 3% phenol.
Results: The patient experienced an immediate reduction of over 80% in pain intensity,
going from a VAS score of 10/10 to 1–2/10. During follow-up, she maintained complete
analgesia at 7 and 15 days (VAS score of 0/10). At three months, clinically significant
improvement persisted with a VAS score of 2/10, without complications attributable to the
procedure.
Conclusion: Ultrasound-guided neurolysis of PECS planes I–II combined with interscalene
block with phenol may represent a useful palliative alternative in patients with refractory
cancer pain secondary to advanced metastatic breast cancer with chest wall infiltration and
severe functional impairment.
Keywords: metastatic breast cancer, refractory cancer pain, chemical neurolysis, phenol, PECS, interscalene block, palliative care
©2026 Quintero, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.
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