[Refractory pain in children with cancer: role of peridural analgesia].
BACKGROUND
Adequate treatment of pain in children with cancer is a critical issue, and is of equal importance as discussions concerning chemotherapy, surgery and radiotherapy.


OBJECTIVE
To evaluate the treatment of refractory pain by peridural analgesia.


METHODS
Seven children (1-15 years) with solid tumors were treated with long term epidural analgesia for refractory pain. Catheters were inserted in epidural space (L1-L2) and infused with sufentanil, bupivacaine and clonidine.


RESULTS
Three out of five children with good response to peridural therapy could be discharged. A 12-month-old infant had a poor response. Treatment was discontinued in a teenager boy because of patient refusal. The side effects were: early catheter displacement in two patients and a bacterial contamination in one. Serious adverse effects related to high doses of opiates were not observed. However, toxicity of bupivacaine was observed in three patients leading to treatment discontinuation in one.


CONCLUSIONS
Long-term epidural analgesia looks promising in selected children with refractory pain.
Service d'oncologie pédiatrique, CHU, hôpital d'enfants de la Timone, Marseille, France.
M
M
Portas
J Y
JY
Marty
C
C
Buttin
J C
JC
Gentet
C
C
Coze
K
K
Fallouh
J L
JL
Bernard
J
J
Camboulives
D000293:Adolescent; D015360:Analgesia, Epidural / Q000295:instrumentation; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010166:Palliative Care; D010342:Patient Acceptance of Health Care; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects
D000701:Analgesics, Opioid; D017409:Sufentanil
Douleurs réfractaires de l'enfant cancéreux: place de l'analgésie péridurale.