title: A case report of dexmedetomidine used to treat intractable pain and delirium in a tertiary palliative care unit.
abstract: BACKGROUND
  This case report describes an end-stage cancer patient with intractable neuropathic pain and delirium who was successfully managed during the last 3 weeks of her life with a continuous subcutaneous infusion of dexmedetomidine.
  
  
  METHODS
  A 55-year-old woman with locally advanced cervical cancer and uncontrolled pelvic pain was admitted to a tertiary palliative care unit for pain management. As her disease progressed, the patient's pelvic pain intensified despite treatment with methadone, gabapentin, ketamine, and hydromorphone administered by continuous subcutaneous infusion plus frequent breakthrough doses of hydromorphone and sufentanil.
  
  
  RESULTS
  A continuous subcutaneous infusion of dexmedetomidine was started and titrated to achieve pain relief.
  
  
  METHODS
  The patient's pain and delirium cleared. The treatment was successful in fulfilling the patient's goal of care: not to be deeply and continuously sedated, but to be rousable and of clear mind while still having good pain control.
  
  
  CONCLUSIONS
  Dexmedetomidine is a potentially useful medication for the targeted treatment of intractable pain and delirium in the tertiary palliative care environment. Future research is required to compare dexmedetomidine infusion to standard treatment with midazolam infusion for treatment of intractable symptoms in the palliative care environment.
authors.affiliation: End of Life Program, Fraser Health Authority, Abbotsford, BC, Canada Neil.Hilliard@fraserhealth.ca.
authors.forename: Neil
authors.initials: N
authors.lastname: Hilliard
authors.affiliation: End of Life Program, Fraser Health Authority, Abbotsford, BC, Canada.
authors.forename: Stuart
authors.initials: S
authors.lastname: Brown
authors.affiliation: End of Life Program, Fraser Health Authority, Abbotsford, BC, Canada.
authors.forename: Steve
authors.initials: S
authors.lastname: Mitchinson
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D003693:Delirium / Q000188:drug therapy*; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D055104:Infusions, Subcutaneous; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy*; D010148:Intractable Pain / Q000188:drug therapy*; D010166:Palliative Care / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000150:complications
chemical_list: D018712:Analgesics, Non-Narcotic; D020927:Dexmedetomidine
keywords: Palliative care; delirium; dexmedetomidine; intractable pain