Continuous Tunnelled Femoral Nerve Block for Palliative Care of a Patient with Metastatic Osteosarcoma

Abstract

Summary An 18-year-old man with metastatic femoral osteosarcoma had inadequate pain control with gabapentin, naproxen, and intravenous fentanyl. A tunneled femoral nerve catheter was used to administer a continuous infusion of 0.2% ropivacaine and 4 μg/mL clonidine (10 mL/h) until his death 88 days later. During discharge from hospital, catheter disconnection resulted in severe pain and readmission. Tunneling, aseptic insertion technique, antibiotics, and sterile infusate prepared by pharmacy may have reduced the chance of infection. We propose that this is a suitable and effective technique in the long-term management of patients with terminal cancer and should be considered on a case-by-case basis.

Ambulatory Continuous Interscalene Blocks for Cancer Pain

“…Success from their extended use has been seen in patients for periods of up to 3 months, with improved pain management and improved ability to perform routine activities. 4 Catheters are placed using nerve stimulation or ultrasound guidance, similar to the procedures used in patients for post-operative analgesia. 3 Through educating both patients and their caregivers about complications and precautions with the catheters, patients, family members, and professional care givers can troubleshoot any problems.…”

“…1,3 Correlations between the duration of catheter placement and risk of infection and inflammation have been found. 4,6 Infections due to the catheter can cause serious complications, including cellulitis, and abscess formation and sepsis. 4,6 Prophylactic antibiotic use has been shown to decrease the chance of infection and inflammation.…”

“…4,6 Infections due to the catheter can cause serious complications, including cellulitis, and abscess formation and sepsis. 4,6 Prophylactic antibiotic use has been shown to decrease the chance of infection and inflammation. 4 Subcutaneous tunneling of the catheter may also decrease the risk of bacterial colonization and infection, as infections are thought to arise from the catheter insertion site on the skin.…”

“…4,6 Prophylactic antibiotic use has been shown to decrease the chance of infection and inflammation. 4 Subcutaneous tunneling of the catheter may also decrease the risk of bacterial colonization and infection, as infections are thought to arise from the catheter insertion site on the skin. 2,4 The purpose of subcutaneous tunneling is to increase the distance between the catheter tip and percutaneous insertion site.…”

“…3 may be useful in cancer patients to control their pain and limit the side effects caused by the increasing dosage of opioids, such as nausea, vomiting, constipation, and sedation. 4,5 We describe two such patients. We made multiple unsuccessful attempts to contact their surviving spouses.…”