title: Retrograde Epidural Catheter Relieves Intractable Sacral Pain.
abstract: Pain caused by tumor infiltration of the sacral area remains a major clinical challenge. Patients with poor pain control despite comprehensive medical management may be treated with neuraxial techniques such as continuous epidural or spinal anesthetic. We report a case in which a patient with metastatic breast cancer experienced inadequate pain relief after multiple intravenous pain management regimens as well as intrathecal (IT) drug delivery. The concentration of local anesthetics delivered via the IT catheter was limited due to the patient's baseline motor weakness which would be exacerbated with higher concentrations of local anesthetics. Thus, a decision was made to insert an epidural catheter via a retrograde technique to provide the patient with a "band of anesthesia" which would provide profound sensory blockade without concomitant motor weakness. Pain refractory to other modalities of pain control was successfully treated with the epidural technique.
authors.affiliation: Department of Anesthesiology, School of Medicine, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Ruchir
authors.initials: R
authors.lastname: Gupta
authors.affiliation: St. George's University School of Medicine, St. George's Medical College, Grenada.
authors.forename: Shivam
authors.initials: S
authors.lastname: Shodhan
authors.affiliation: Department of Anesthesiology, New York Medical College, NY, USA.
authors.forename: Amr
authors.initials: A
authors.lastname: Hosny
keywords: Epidural catheter; Intractable cancer pain; Retrograde catheter; Sacral pain