Background & Aims

– Iliopsoas muscle injections (IPMI) are an established intervention for control of localized pain of myofascial origin in the abdominal right lower quadrant and groin, whether chronic cancer or non-cancer related pain.

– IPMI is usually performed under no imaging or ultrasound-guidance.

– Risks associated with IPMI’s are relatively minimal, which include infection, bleeding, bruising, and vascular injury.

– IPMI’s have been shown to be beneficial in patients suffering from post-operative abdominal cancer pain, notably in the post-operative state.

– Limited literature exists with regards to performing IPMI’s under fluoroscopic-guidance. They are usually performed with, if any, ultrasound assistance.

– To discuss a case where an IPMI was extremely beneficial to a cancer patient who was experiencing post-treatment abdominal and groin pain.

– To bring awareness to a novel technique for IPMI’s, that has been seldomly reported in the literature.

Methods

A 40-year-old male with a synovial sarcoma of the right psoas muscle status-post surgical resection. Post-operatively patient was suffering from right lower quadrant pain with radiation the right flank, as well as groin pain, at a severity of 7/10. Given the presentation, pain was thought to originate from the iliopsoas muscle. Decision was made to the have the patient undergo IPMI of the iliopsoas muscle, under fluoroscopy . The patient was placed supine with the right lower extremity in the flexed abducted position. The area of interest was sterilized with a chlorhexidine solution. In the AP view under fluoroscopy, the femoral head was located and marked with the use of surgical pickups. A 22-gauge, 3.5 inch spinal needle was then advanced to the expected region of the iliopsoas muscle. Omnipaque 300 contrast of about 0.5mL was injected to obtain a iliopsoas myelogram. A total IPMI solution of 5mL ( 1mL Kenalog 40mg/mL and 4mL Bupivacaine 0.25%) was injected.

Results

Post-procedure, patient noted his pain severity to be 0/10. Patient tolerated the overall procedure well, without complications.

Conclusions

-Through this novel approach, patient’s pain relief was immediately apparent post-procedure, thus improving quality of life.

– After careful avoidance of the vascular bundle and precise localization of the iliopsoas muscle, post-procedure complications were non-existant.

-Although IPMI’s are conventionally performed under ultrasound or no imaging guidance, fluoroscopy is another safe and effective tool that pain providers can utilize to help treat post-operative abdominal and groin cancer pain.

References

-Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiol Clin. 2007 Dec;25(4):841-51, vii-iii. doi: 10.1016/j.anclin.2007.07.003. PMID: 18054148.

-Kim DS, Jeong TY, Kim YK, Chang WH, Yoon JG, Lee SC. Usefulness of a myofascial trigger point injection for groin pain in patients with chronic prostatitis/chronic pelvic pain syndrome: a pilot study. Arch Phys Med Rehabil. 2013 May;94(5):930-6. doi: 10.1016/j.apmr.2012.12.011. Epub 2012 Dec 21. PMID: 23262156.

-Alnahhas MF, Oxentenko SC, Locke GR 3rd, Hansel S, Schleck CD, Zinsmeister AR, Farrugia G, Grover M. Outcomes of Ultrasound-Guided Trigger Point Injection for Abdominal Wall Pain. Dig Dis Sci. 2016 Feb;61(2):572-7. doi: 10.1007/s10620-015-3857-8. Epub 2015 Aug 30. PMID: 26320087.

Presenting Author

Shawn Sidharthan

Poster Authors

Shawn Sidharthan

M.D.

UT-MD Anderson Cancer Center

Lead Author

Nour Abdullah M.D.

UT-MD Anderson Cancer Center

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Injections/Blocks