REGIONAL ANESTHESIA FOR PAIN ASSOCIATED WITH TERMINAL PEDIATRIC MALIGNANCY

The objectives of this study were to identify the characteristics of c hildren who required regional anesthesia for pain associated with term inal malignancy and to identify the safety, tolerability and effective ness of regional anesthesia as an analgesic modality in terminal pedia tric malignancy, A retrospective examination was made of the medical r ecords of children who died of malignancy following treatment at the D ana-Farber Cancer Institute and Children's Hospital, Boston, Massachus etts, and who required either epidural or subarachnoid infusions, or n eurolytic blockade for pain management(June, 1986 - April, 1994) durin g the terminal phase of their illness, Eleven patients were identified , with a duration of epidural or subarachnoid infusions ranging from 3 days to 7 weeks. Indications for this intervention included limiting side effects of opioids, neuropathic pain unresponsive to either rapid escalation of opioids or massive opioid infusions, analgesia for thor acocenteses for the drainage of malignant pleural effusions and instil lation of intrapleural chemotherapy. Pain was localized to one area in all patients. Analgesia was judged to be satisfactory in all cases af ter regional anesthesia was instituted and remained satisfactory in al l cases throughout the treatment course, Complications associated with regional anesthesia included dural puncture headache and mild respira tory depression, Five patients were nursed at home with either epidura l or subarachnoid infusions,