title: Intrathecal infusion of bupivacaine and clonidine provides effective analgesia in a terminally ill child.
abstract: 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.
authors: Department of Pediatric Anesthesia, BC Children's Hospital, Vancouver, BC, Canada.
authors: Emma
authors: E
authors: Whyte
authors: Gillian
authors: G
authors: Lauder
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D003000:Clonidine / Q000008:administration & dosage / Q000627:therapeutic use*; D017809:Fatal Outcome; D006801:Humans; D007223:Infant; D007278:Injections, Spinal; D008297:Male; D059408:Pain Management / Q000379:methods*; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D011471:Prostatic Neoplasms / Q000150:complications; D011788:Quality of Life; D012208:Rhabdomyosarcoma / Q000150:complications; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill
chemical_list: D000316:Adrenergic alpha-Agonists; D000779:Anesthetics, Local; D003000:Clonidine; D002045:Bupivacaine