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

Paediatr Anaesth

Department of Pediatric Anesthesia, BC Children's Hospital, Vancouver, BC, Canada.

Published: February 2012

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.

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Source
http://dx.doi.org/10.1111/j.1460-9592.2011.03672.xDOI Listing

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