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American Journal of Hospice and Palliative Medicine®
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Phenol saddle blocks for intractable pain at end of life: Report of four cases and literature review

Neal E. Slatkin, MD

Department of Supportive Care and Palliative Medicine, City of Hope National Medical Center, Duarte, California

Michelle Rhiner, RN, MSN, NP

Department of Supportive Care and Palliative Medicine, City of Hope National Medical Center, Duarte, California

Four cancer patients with prior bladder diversions had phenol neurolytic saddle blocks performed for intractable pelvi-sacral pain. All patients had advanced disease, the focus of their treatment being palliative. Treatment limiting side effects precluded further upward titration of systemic analgesic therapies. Pain control improved after intrathecal neurolysis and allowed a greater than 60 percent reduction in systemic opiate dosage. No significant block-related adverse effects were encountered. The value and technical aspects of intrathecal saddle blocks in end-of-life pain management is discussed.

Key Words: pain management • saddle blocks • pelvi-sacral pain • neurolytic blocks

American Journal of Hospice and Palliative Medicine®, Vol. 20, No. 1, 62-66 (2003)
DOI: 10.1177/104990910302000114
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[Abstract] [PDF]


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