Introduction:

Desmoid type fibromatosis can cause significant pain due to
neurovascular compression and space-occupying effects

Cryoablation is an effective treatment for extra-abdominal
fibromatosis.

However, post-cryoablation pain can present challenges,
with no standardized analgesic strategy.

Case: interscalene brachial plexus blockade (ISB) to
manage chronic and post-procedural pain following
recurrent cryoablation procedures for shoulder fibromatosis.

 

Methods:

Interscalene Brachial Plexus Block (ISB)

Brachial plexus from supraclavicular fossa, and
corresponding cervical nerve roots were identified

21-gauge needle advanced in-plane to the target site,
followed by injection of 10 ml of 1.3% liposomal bupivacaine
and 10 ml of 0.25% bupivacaine.

Pectoserratus Fascial Plane Block

For additional chest wall and axillary coverage

Anterolateral chest wall, injection below pectoralis minor
over the corresponding rib

20 ml of 0.25% bupivacaine administered

 

Case Report:

Patient: 46-year-old woman with right shoulder desmoid
fibromatosis s/p failed systemic therapy and prior surgical
resection

Undergoing serial CT-guided cryoablation for tumor control and
pain palliation

Progressive shoulder pain radiating to the axilla and lateral
chest, limiting daily function.

Intervention: CT-guided cryoablation targeting tumor involvement
of the anterior joint capsule, chest wall, and brachial plexus
followed by regional anesthesia with interscalene block (ISB) and
pectoserratus block for postoperative analgesia.

Outcome: Significant pain relief over 48 hours, reduced inpatient
opioid requirements compared to baseline (Oxycodone 15 mg
PRN at home)

Maintained multimodal regimen of acetaminophen, ketorolac,
gabapentin and PRN methocarbamol

Discharge on PRN oxycodone, pain score 2/10

Subsequent Course: The patient underwent two additional
cryoablations with a similar regional anesthesia strategy applied to
each clinical scenario

Progressive tumor involvement led to increased axillary pain
and brachial plexus neuropathy over time, requiring
hydromorphone PCA for breakthrough pain despite regional
blockade.

 

Discussion:

Desmoid type fibromatosis often requires escalating opioid
regimens for management of pain symptoms.

Serial cryoablation treatments are an effective treatment
modality, but can contribute to additional pain symptoms.

Our case demonstrates the
benefit of incorporating regional
anesthesia to facilitate
post-cryoablation and tumor
related pain in the non-OR
setting.