Palliative care with cervical intrathecal infusion and exterior pump for a late-stage most cancers affected person with refractory ache: A case report.
Drugs (Baltimore). 2018 Jan;97(four):e9714
Authors: Ju Y, Tian D, Tan Y, Fu Z
RATIONALE: Intrathecal remedy, with a low complication price, has change into a substitute for normal ache administration for remedy of neuropathic most cancers ache.
PATIENT CONCERNS: Right here, we reported a late-stage most cancers affected person with intractable neuropathic ache in his proper neck, shoulder, and higher limb.
DIAGNOSES: The ache began 2 years in the past when the affected person was identified as squamous cell carcinoma with metastasis to proper supraclavicular lymph nodes.
INTERVENTIONS: Cervical intrathecal infusion of morphine and bupivacaine with affected person management analgesia by exterior pump was carried out. The intrathecal catheter was positioned on the stage of C6 vertebra. The preliminary focus of bupivacaine and morphine had been each 1?mg/mL with infusion price of zero.three?mL/h and bolus of zero.three mL. Subsequently, the concentrations elevated to 2?mg/mL (bupivacaine) and 1.33?mg/mL (morphine), with infusion price to zero.6?mL/h and bolus to zero.5?ml.
OUTCOMES: The ache depth decreased from numerical score scale 6 to 7 to 2 to three at relaxation, and from 10 to five to six of breakthrough ache.
LESSONS: In conclusion, cervical intrathecal infusion requires low focus however excessive doses of bupivacaine and morphine, which is protected and efficient in most cancers sufferers with refractory ache and quick life expectancy.
PMID: 29369202 [PubMed – in process]