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Intrathecal infusion of bupivacaine and clonidine provides effective analgesia in a terminally ill child
Author(s) -
Whyte Emma,
Lauder Gillian
Publication year - 2012
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2011.03672.x
Subject(s) - medicine , clonidine , bupivacaine , anesthesia , intrathecal , refractory (planetary science) , intractable pain , morphine , local anesthetic , hydromorphone , opioid , physics , receptor , astrobiology
Summary 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.