What happened, in summary

A 69-year-old woman had been living with breast cancer for two years and had known bone metastasis at the T4–T5 vertebrae. Despite a 50 mcg fentanyl patch and paracetamol 1000 mg four times daily, she described severe pain spanning the upper and mid-back and rated it 8/10.

To provide faster relief without escalating injectable opioids, clinicians performed bilateral erector spinae plane blocks at the T3 and T6 levels. Each injection used bupivacaine, dexamethasone, and saline under ultrasound guidance. Within 30 minutes, sensory testing showed a broad block from C8 to T10, and her pain score fell below 2. She did not need additional rescue medication during the first 24 hours and had no procedure-related complications.

She was referred to the pain clinic for adjustment of her fentanyl patch. When severe pain returned during the following six months, she chose to have the same block repeated rather than stay in hospital for a nerve-block catheter. The repeat procedure provided a pain-free interval while the higher fentanyl dose took effect. The report focused on symptom control for metastatic breast cancer rather than the status of her anticancer treatment.