Intrathecal infusion of bupivacaine and clonidine provides effective analgesia in a terminally ill child

Abstract

The intrathecal infusion of drugs to provide analgesia for terminally ill children with refractory pain is a rarely utilized but very effective technique. A number of pharmacological agents, most commonly opioids and local anesthetics, have been administered intrathecally for this purpose. However, tachyphylaxis and neuraxial opioid-related side effects can limit their utility. The alpha-2 agonist clonidine is commonly used to augment local anesthetic techniques for postsurgical pain in children and for the management of refractory cancer pain in adults, but there is only a single report of the use of clonidine intrathecally in a terminally ill child. We present the case of the youngest reported child to have received intrathecal analgesia for terminal care: a 3-year-old boy with advanced pelvic rhabdomyosarcoma, whose refractory pain was managed effectively with an intrathecal infusion of bupivacaine and preservative-free clonidine.

Long-Term Intrathecal Analgesia With a Wireless Analgesia Pump System in the Home Care of Patients With Advanced Cancer

“…Our previous study and other studies have shown that ITDD is more effective than conservative delivery methods. 2 –5 The infusion pump must be quite accurate as it injects medication directly into the CSF. To be on the safe side, programmable devices such as Medtronic’s SynchroMed system have often been applied to long-term intrathecal analgesia.…”

“…Previous studies have been more focused on the efficacy and side effects of intrathecal application of opioids or opioids plus adjuvants (bupivacaine, clonidine, and others). 3 –5 However, the appropriate intrathecal drug delivery (ITDD) systems also play a vital role in the management of long-term intrathecal analgesia. There are 2 types of ITDD systems, an implantable drug delivery system and an exteriorized system with an external pump.…”

Interventional Procedures for Chronic Pain in Children and Adolescents: A Review of the Current Evidence

“…Farid and Heiner successfully treated an 8‐year‐old girl with chronic left foot pain by placing an intrathecal catheter at the L4‐5 spinal space and infusing 0.2% ropivacaine at 0.03 mg/kg/h for 1 week . Intrathecal clonidine administration, which is commonly performed in adults, has also been reported in a terminally ill child . Baclofen has been administered intrathecally to manage refractory spasticity and dystonia in children with multiple sclerosis, cerebral palsy, traumatic brain injury, spinal cord injury, transverse myelitis, and other conditions .…”

Prise en charge des douleurs associées aux méningites néoplasiques en pédiatrie

“…Néanmoins, il n'existe que très peu de données sur les traitements antalgiques ou les anesthésies locales par voie IT avec pompes implantables. Si le taux de succès de l'analgésie IT est estimé entre 65 et 95 % selon les séries d'adultes [52], il est difficile à évaluer chez l'enfant du fait du manque de données [53]. La voie ICV qui impose un acte neurochirurgical bénin (mise en place d'un cathéter intraventriculaire relié à un réservoir d'Omaya sous le cuir chevelu) est peu décrite en pédiatrie.…”