Intrathecal infusion of bupivacaine and clonidine provides effective analgesia in a terminally ill child.

Abstract

The intrathecal infusion of drugs to provide analgesia for terminally ill children with refractory pain is a rarely utilized but very effective technique. A number of pharmacological agents, most commonly opioids and local anesthetics, have been administered intrathecally for this purpose. However, tachyphylaxis and neuraxial opioid-related side effects can limit their utility. The alpha-2 agonist clonidine is commonly used to augment local anesthetic techniques for postsurgical pain in children and for the management of refractory cancer pain in adults, but there is only a single report of the use of clonidine intrathecally in a terminally ill child. We present the case of the youngest reported child to have received intrathecal analgesia for terminal care: a 3-year-old boy with advanced pelvic rhabdomyosarcoma, whose refractory pain was managed effectively with an intrathecal infusion of bupivacaine and preservative-free clonidine.

• Authors: Emma Whyte, Gillian Lauder
• Journal: Paediatric anaesthesia (Paediatr Anaesth) Vol. 22 Issue 2 Pg. 173-5 (Feb 2012) ISSN: 1460-9592 [Electronic] France
• PMID: 21880097 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2011 Blackwell Publishing Ltd.

Chemical References

• Adrenergic alpha-Agonists
• Anesthetics, Local
• Clonidine
• Bupivacaine

Topics

• Adrenergic alpha-Agonists (administration & dosage, therapeutic use)
• Anesthetics, Local (administration & dosage, therapeutic use)
• Bupivacaine (administration & dosage, therapeutic use)
• Clonidine (administration & dosage, therapeutic use)
• Fatal Outcome
• Humans
• Infant
• Injections, Spinal
• Male
• Pain Management (methods)
• Pain, Intractable (drug therapy, etiology)
• Prostatic Neoplasms (complications)
• Quality of Life
• Rhabdomyosarcoma (complications)
• Terminal Care (methods)
• Terminally Ill