Adriamycin injection into the medial cord of the brachial plexus: computed tomography-guided targeted pain therapy

Pain Med. 2008 Jan-Feb;9(1):83-7. doi: 10.1111/j.1526-4637.2006.00139.x.

Abstract

Recent advances in radiographic imaging technology allow for therapeutic agents to be placed within the subepineurium of peripheral nerve tissue. Adriamycin, a chemotherapeutic agent, is retrogradely transported by nerves to their cell bodies residing in the dorsal root ganglia. The combined process of radiological approach, an understanding of the anatomy of the brachial nerve plexus, and the use of agents that are retrogradely transported by nerves allows for targeted neuroablation of nerves. Advantages of this allow for the use of very small volumes of even toxic drugs, the volume of which allows for safe administration. Here, we report on the transcutaneous computed tomography (CT)-guided injection of adriamycin into specific branches of the brachial plexus in a patient with metastatic cervical cancer involving the lower plexus whose pain was untreatable by aggressive medical therapy that included epidural trials of opioids. Identification of the medial brachial cord was achieved using CT-guided techniques that included accurate localization with intra-neural dye injection, followed by injection of 0.5 mg of adriamycin. The patient reported complete pain relief within 12 h of the injection.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibiotics, Antineoplastic / administration & dosage
  • Antibiotics, Antineoplastic / therapeutic use*
  • Brachial Plexus*
  • Doxorubicin / administration & dosage
  • Doxorubicin / therapeutic use*
  • Drug Resistance
  • Female
  • Humans
  • Injections
  • Low Back Pain / drug therapy*
  • Low Back Pain / etiology
  • Pain, Intractable / diagnostic imaging
  • Pain, Intractable / drug therapy*
  • Pain, Intractable / etiology
  • Tomography, X-Ray Computed
  • Uterine Cervical Neoplasms / complications

Substances

  • Antibiotics, Antineoplastic
  • Doxorubicin