Chronic Cancer-Related Pain: Continuous Perineural Infusion of Local Anesthetics as Alternative to Systemic Analgesic Drugs

Abstract

Pain is a major concern for patients suffering from cancer. Although opioid drugs remain the gold standard for treatment of pain, little is known about the interest of continuous analgesia techniques as alternative. The aim of the present article is to detail the feasibility and to present the diversity of continuous perineural infusion of local anesthetic. A series of five patients suffering from different cancer-related pain is presented. A continuous perineural block was proposed to patients presenting with unbearable pain in an area innervated by a plexus or a nerve despite parenteral analgesic pharmacotherapy. All blocks were performed in a surgical theatre under sterile conditions. An initial bolus dose with 3.75 mg/mL ropivacaine was injected followed by a continuous infusion of 2 mg/mL of ropivacaine. Patient-controlled perineural analgesia was started at home by a nursing network. The technique, the efficacy, and the side effects were reported. Complete pain relief was noted 15 minutes after local anesthetic injection in the five cases, and efficacy was maintained during the following days at home, with no other analgesic treatment required. One patient restarted working a few weeks after catheter insertion. The catheter duration lasted for 12 to 110 days. One catheter was removed because of local anesthetic leak at the puncture point. Some paresthesia was noted in one patient. No other side effect was noted. No infection was reported. In selected patients, continuous perineural infusion of local anesthetics appears to be an attractive alternative to parenteral opioids for cancer-related pain. Further investigation is warranted to better define the place of these techniques in the armamentarium of cancer-related pain treatment.

A case report of sustained resolution of cancer pain by continuous perineural infusion of local anaesthetic

“…Patient selection remains key. Several analgesic techniques can be used, depending on the location of the pain (Fuzier et al., ). The considerable improvement in pain scores observed in our patient, notably for the mental and social items of the SF12, compared with scores before catheter placement, and its persistence for up to 3 months following catheter removal confirm the usefulness of this analgesic technique.…”

“…In most patients inserted with a perineural catheter, the pain disappears within 30 min of the first injection of local anaesthetic and remains bearable throughout the patient‐controlled administration period of several weeks. Surprisingly, in some cases we have treated, the pain relief has persisted well beyond the removal of the catheter (Fuzier et al., ).…”

“…However, these drugs have potentially undesirable effects on the immune system, especially with prolonged administration (Vallejo, de Leon-Casasola, & Benyamin, 2004). For certain well specified indications (i.e., pain limited to the territory of a nerve or plexus), continuous regional analgesia by prolonged perineural infusion of local anaesthetics could represent an alternative to opioids (Fuzier, Izard, Cabos, Chaminade, & Pouymayou, 2016). Its analgesic effects are superior to those of morphine, with none of the side effects.…”

Effects of Dexmedetomidine as an Analgesic Adjuvant for Surgery of Femur Fracture: A Systematic Review and Meta-Analysis

“…Over the years, the invention for pain that relates to general and local anesthesia includes lidocaine, bupivacaine, opioids, and nonsteroidal anti-inflammatory drugs [2][3][4]. However, these anesthetics may result in a high risk of respiratory depression and increase the risk of opioid-induced hyperalgesia in patients with surgery of femur fracture [2]. In order to maximize pain relief and decrease opioid requirement, multimodal applications using different classes of analgesic adjuvants are currently recommended.…”

“…Patients who undergo surgery of femur fracture always suffer the excruciating pain, which can affect psychological state and delay the time of discharge [1]. Over the years, the invention for pain that relates to general and local anesthesia includes lidocaine, bupivacaine, opioids, and nonsteroidal anti-inflammatory drugs [2][3][4]. However, these anesthetics may result in a high risk of respiratory depression and increase the risk of opioid-induced hyperalgesia in patients with surgery of femur fracture [2].…”