<p>Rectal enema of bupivacaine in cancer patients with tenesmus pain – case series</p>

Abstract

Introduction: Rectal tenesmus pain in cancer patients most frequently appears in patients with colon cancer, and as a consequence of radiotherapy of the hypogastrium region. Treatment with opioids and adjuvant analgesics is often ineffective. Patients and methods: Here, we report on two female patients diagnosed with colon and ovary cancer, respectively, who had very severe tenesmus pain (numerical rating scale 8–10) despite using high doses of opioids, including methadone with corticosteroids, anticonvulsants, antidepressants and ketamine. Results: In both patients, bupivacaine was administered via a rectal enema. In the first patient, bupivacaine was administered at a dose of 100 mg 0.1% (100 mL), and subsequently 100 mg 0.2% (50 mL), leading to effective analgesia for 8 and 12 hrs, respectively. In the second patient, 100 mg 0.1% (100 mL) was initially administered, followed by 100 mg 0.2% (50 mL), leading to effective analgesia for 12 and 17 hrs, respectively, with only dull abdominal pain reported that was relieved by 100 mg IV ketoprofen and complete disappearance of tenesmus pain. Rectal bupivacaine administration did not cause neurologic adverse effects, heart function disturbances or decreased blood pressure. A volume of 50 mL was enough to cover a painful area in the colon. Initial bupivacaine concentrations in the blood serum did not exceed 50 ng/mL and eventually dropped to 20 ng/mL and below. Conclusions: Administration of 100 mg bupivacaine as a rectal enema is safe and provides effective analgesia, and this procedure may be conducted in hospital departments and out-patient clinics. Furthermore, this procedure in the case of pain recurrence, can be repeated, and by providing effective pain relief often allows time for the patient to be transferred to a specialized pain center.

Development of S75:R25 bupivacaine‐loaded lipid nanoparticles functionalized with essential oils for treating melanoma

“…In addition, BVC S75 encapsulated in functional NLC showed greater in vivo anesthetic activity and could be used also to treat pain associated with tumor treatment. 70,71 These results indicate that the goal of developing a BVC S75 -in-functional NLC system to treat melanoma has been reached, with two formulations of improved antitumoral activity in vitro, prolonged anesthetic effect in vivo and sustained release at the site of action.…”

Localized Drug Delivery Systems: An Update on Treatment Options for Head and Neck Squamous Cell Carcinomas

“…Rectal delivery is mainly used for very localized conditions, with some instances of usage for colon cancer [ 124 , 132 ]. The highly vascularized environment allows for rapid systemic absorption in case of emergencies [ 124 ].…”

Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic

“…As the rectal mucosa is highly vascularised, this route of administration is useful for rapid systemic drug absorption, particularly in an emergency or when the oral route is unavailable. Rectal formulations have been used in pain management [ 102 , 103 ], sedation [ 104 ] and treatment of seizures [ 105 ]. Compared to other transmucosal routes of administration, one of the distinct advantages of rectal delivery is that it is not limited by vomiting which patients commonly experience as they approach the ends of their lives.…”