Subarachnoid neurolytic block under general anesthesia in a 3-year-old with neuroblastoma.
METHODS
A 3-year-old boy with neuroblastoma complained of severe pain in the left lower extremity. Pharmacologic management had previously been attempted, but severe pain continued, and further upward titration was complicated by sedative effects.


RESULTS
Because the focus of treatment had become the controlling of pain, a lumbosacral subarachnoid neurolytic block was performed under general anesthesia. One-time neurolysis was more acceptable to the family than a procedure like epidural analgesia, that requires greater management. Contrast medium was used to monitor the spread of the neurolytic. An epidural catheter was inserted during the neurolytic block procedure for possible future use. The short-term results were good--pain reports and opioid doses decreased greatly, although with increased incontinence. The boy had new abdominal distention and pain 5 days after neurolysis. Opioid doses and sedatives were increased. He died 3 days later.
Patt
R B
RB
Department of Anesthesiology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Payne
R
R
Farhat
G A
GA
Reddy
S K
SK
D000768:Anesthesia, General; D001932:Brain Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D002675:Child, Preschool; D006801:Humans; D007267:Injections; D007866:Leg; D008297:Male; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block; D009447:Neuroblastoma / Q000150:complications* / Q000000981:diagnostic imaging; D010146:Pain / Q000000981:diagnostic imaging / Q000209:etiology; D059408:Pain Management; D011859:Radiography; D013346:Subarachnoid Space
D009294:Narcotics