Broadening the Indications for the SPING Block in Palliative Care: A Case Discussion

The Spinal Phenol IN Glycerol (SPING) block is an intrathecal neurolytic technique developed to provide sustained unilateral analgesia in frail patients with nonoperative hip fractures. Its potential role in other palliative care populations remains unexplored. Two cases are described with refractory unilateral lower-limb pain: a 76-year-old male with metastatic esophageal cancer and acetabular metastasis, and an 86-year-old female with advanced dementia and critical limb ischemia. In both cases, systemic opioids failed and were associated with significant adverse effects. Both patients experienced rapid and clinically assessed sustained pain relief, reduced opioid requirements, and improved comfort until death. These two case reports suggest that SPING may provide effective palliative analgesia with opioid reduction in patients with refractory unilateral lower-limb pain caused by metastatic bone disease and critical limb ischemia. These findings support consideration of SPING as a proportionate palliative intervention beyond its current use for hip fractures when comfort is the primary goal.