Effectiveness of subarachnoid drug infusion for pediatric tumor-related pain.
Although the effectiveness of subarachnoid continuous drug infusion has been established in cancer pain management, its clinical use in children is rare. A 14-year-old girl with neurofibromatosis type I complained of right leg pain stemming from a growing tumor on her right buttock. Continuous and breakthrough right leg pain were unbearable, even at high doses of systemic opioids that caused severe constipation and deep sedation. Subsequent continuous infusion of bupivacaine and morphine through a subarachnoid catheter effectively relieved the girl's pain. The corresponding decrease in systemic opioid also improved her activities of daily living. The patient eventually died of cachexia due to the rapidly growing buttock lesion that was pathologically confirmed post-mortem as a malignant peripheral nerve sheath tumor. Subarachnoid continuous drug infusion may be very useful in controlling severe pain with few side-effects, even in the field of pediatric palliative care.
Department of General Pediatrics, Nagano Children's Hospital, Azumino, Nagano, Japan.
Tsukasa
T
Higuchi
Department of General Pediatrics, Nagano Children's Hospital, Azumino, Nagano, Japan.
Kazuhiro
K
Shimada
Department of General Pediatrics, Nagano Children's Hospital, Azumino, Nagano, Japan.
Yoshiaki
Y
Cho
Department of General Pediatrics, Nagano Children's Hospital, Azumino, Nagano, Japan.
Kisei
K
Minami
Department of General Pediatrics, Nagano Children's Hospital, Azumino, Nagano, Japan.
Kouichi
K
Takeuchi
Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Akiyuki
A
Sakamoto
D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000072716:Cancer Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D010147:Pain Measurement; D010386:Pelvic Neoplasms / Q000150:complications*; D013346:Subarachnoid Space
D000701:Analgesics, Opioid
bupivacaine; malignancy; morphine; neuropathic pain; subarachnoid