What happened, in summary

A 45-year-old woman had been diagnosed with breast cancer two years earlier and had multiple bone metastases from T3 through T7. She was using a 100 mcg fentanyl patch and dexketoprofen 50 mg four times daily, yet pain across the upper back remained severe. She rated it 9/10.

Because additional high-dose injectable opioids would require emergency monitoring and might provide only short-lived relief, clinicians performed ultrasound-guided erector spinae plane blocks at two thoracic levels. Bilateral injections at T3 and T6 contained bupivacaine, dexamethasone, and saline. After 30 minutes, sensory testing showed coverage from T1 to T9, and her pain score had fallen below 2. She required no rescue analgesic during the first 24 hours and experienced no complications from the procedure.

The pain clinic then adjusted her fentanyl patch. During the next six months, she returned when severe pain recurred. She declined placement of a continuous nerve-block catheter because she did not want hospitalization, so the same two-level procedure was repeated. It provided a pain-free interval until the increased fentanyl dose began working. Her cancer treatment and broader disease course were not described in the case report.