# Caudal Neuraxial Blocks for Pain Relief From Pelvic Neuropathy Caused by Extensive Diffuse Large B-cell Lymphoma

## TL;DR

A 29-year-old man with advanced lymphoma and severe pelvic neuropathy found pain relief through caudal and sciatic nerve blocks.

## Contribution

This case highlights the potential efficacy of caudal neuraxial blocks in managing cancer-related neuropathic pain.

## Key findings

- The patient experienced pain relief after caudal and sciatic nerve blocks following sepsis resolution.
- Imaging confirmed metastasis to the brain, leading to hospice care after a palliative discussion.
- The case suggests a role for neuraxial blocks in managing refractory cancer-related neuropathic pain.

## Abstract

Central neuraxial blocks can be a vital therapeutic tool for neuropathic pain, but they are infrequently implemented for pain management in cancer patients. Upon a literature review, further data on the role or efficacy of central nerve blocks for neuropathic cancer pain would be beneficial. Additionally, evidence-based guidelines and practices are lacking regarding additional interventions for neuropathic pain relief, a common manifestation of cancer burden. Here, we report the case of a 29-year-old male patient who presented in the ED with intractable neuropathic pain from extensive diffuse large B-cell lymphoma. The patient demonstrated left lower extremity pain, fevers, chills, and tenderness with erythema over the site of his port-a-catheter on his chest. The patient was also hypotensive, despite IV fluid resuscitation. Recent imaging showed a hypermetabolic soft tissue mass in the left upper quadrant of the abdomen. There was also extensive cancer spread in the peripheral pelvis, presacral region, and within multiple sacral foramina, with a secondary perineural spread of the tumor. The patient previously positively responded to a caudal nerve block at an outpatient pain clinic. The patient was admitted to the ICU for three days, and following the resolution of sepsis, the patient received caudal and sciatic nerve blocks on admission day 8. Upon further imaging showing metastasis to the brain, the patient was discharged to inpatient hospice on hospitalization day 10 following a palliative conversation with the patient and family.