467: Breaking new ground: Stellate Ganglion Block in Advanced Cancer- A first in Bataan General Hospital

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic cancer related pain, Pain in Special Populations , Treatment/management , Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Advanced breast cancer produces complex, debilitating pain that often persists despite opioid-based regimens. Stellate Ganglion Block (SGB), a sympathetic blockade targeting cervicothoracic neural pathways, is emerging as an adjunct intervention for cancer-related pain and lymphedema, yet remains under-utilized in metastatic disease. This case presents Bataan General Hospital and Medical Center’s first documented application of SGB in a Stage IV breast cancer patient with severe refractory pain. The goal was to evaluate SGB’s effect on pain intensity, upper-limb swelling, sleep disturbance, and quality of life. This report aims to highlight interventional pain procedures as essential components of multimodal oncology care.

Methods: A 63-year-old woman with Stage IV breast cancer and uncontrolled 10/10 pain despite opioids and adjuvants underwent ultrasound-guided SGB under monitored anesthesia care. Pre-procedure evaluation classified her as ASA IV. Using C6 transverse process sonographic guidance, a 25-gauge needle was advanced toward the longus colli plane and 10 mL of a bupivacaine-dexamethasone-saline mixture was injected. Temperature differentials, Horner’s syndrome, perfusion index changes, and real-time pain scoring were used as markers of successful blockade. Post-procedural assessment included pain scale monitoring, arm mobility evaluation, sleep pattern assessment, and wound-related functional tolerance within the first 24 hours.

Results: Pain intensity decreased dramatically from 10/10 to 3/10 within hours, accompanied by visible limb warming and onset of Horner’s syndrome confirming sympathetic blockade. The patient reported improved sleep, greater ease in repositioning, and reduced upper-limb heaviness. Lymphedema-associated tension lessened sufficiently to allow assisted elevation of the affected arm for the first time in weeks. Opioid rescue dosing declined, affect brightened, and emotional distress eased notably. No hemodynamic instability, respiratory compromise, or neurologic deficits occurred. This case demonstrates rapid analgesic benefit and functional recovery following SGB in a metastatic breast cancer patient with opioid-refractory pain.

Conclusions: SGB delivered fast, meaningful analgesia and functional improvement where conventional therapy failed—showing its potential as a powerful interventional tool in advanced cancer pain. By modulating sympathetic drive, SGB may reduce neuropathic components, improve blood flow, alleviate lymphedema-related pressure, and restore a degree of autonomy and comfort to terminal patients. Its opioid-sparing effect also carries safety advantages in poly-medicated oncology populations. This landmark case supports incorporating SGB into multimodal pain frameworks and encourages further prospective research to define dosing, timing, and repeat-block protocols. For patients living with relentless metastatic pain, SGB may offer relief—and dignity—when few options remain.

References: • American Cancer Society. Cancer Facts & Figures 2023. American Cancer Society, 2023, www.cancer.org/cancer/breast-cancer/statistics.
• Barash, Paul G., et al. Clinical Anesthesia. 9th ed., Wolters Kluwer,
• Singh, A., and S. Bajwa. "Role of Stellate Ganglion Block in Cancer Pain Management." Indian Journal of Pain, vol. 35, no. 2, 2021, pp. 94–101.
• Smith, J. R., et al. "Stellate Ganglion Block in Sympathetic Pain Syndromes: Mechanisms and Outcomes." Pain Medicine, vol. 21, no. 8, 2020, pp. 1233–1242.
• Uchida, Rie, et al. "Efficacy of Stellate Ganglion Block for Cancer-Associated Pain: A Clinical Study." Journal of Pain Management, vol. 11, no. 4, 2018, pp. 345-354.

Presenting Author: LESLIE ANN D.OTCHENGCO MD
Submitting Author: LESLIE ANN OTCHENGCO

Senior Author: LESLIE ANN D.OTCHENGCO MD

IASP 2026 Global Year theme of Neuropathic Pain: Yes