Positive effect of regional analgesia (RA) in terminal stage paediatric chondrosarcoma: a case report and the review of the literature.
A 10-year-old girl was treated for progressive left pelvic chondrosarcoma and severe local pain radiating to the ipsilateral lower extremity. Despite high doses of opioids, pain was poorly controlled and treatment resulted in urine retention and constipation. Positive effect on pain (143 out of 181 days) was obtained by regional analgesia. Continuous lumbar epidural opioid infusion led to pain relief and disappearance of symptoms. Port-catheter dysfunction necessitated a change of epidural catheter and the patient was treated that with morphine, bupivacaine and clonidine plus clonazepam which resulted in relief of constipation and restoration of urinary function. The patient subsequently developed an abscess required or subarachoid infusion (morphine associated with clonazepam, clomipramine and corticosteroids). Later bilateral controlateral cordotomy was performed due to absence of analgesia and the patient subsequently died of tumour progression.
Queinnec
M C
MC
Institut Curie, 26, rue d'Ulm, 75248 Paris, Cedex, France.
Estève
M
M
Vedrenne
J
J
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D015360:Analgesia, Epidural; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D002813:Chondrosarcoma / Q000503:physiopathology*; D002997:Clomipramine / Q000008:administration & dosage / Q000627:therapeutic use; D002998:Clonazepam / Q000008:administration & dosage / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology*; D010386:Pelvic Neoplasms / Q000503:physiopathology*; D013727:Terminal Care
D000305:Adrenal Cortex Hormones; D002998:Clonazepam; D009020:Morphine; D002997:Clomipramine