PERIPHERAL-NERVE CATHETERIZATION IN THE MANAGEMENT OF TERMINAL CANCERPAIN

Background and Objectives. Peripheral nerve catheterization techniques were used in two patients with severe pain associated with the termin al stages of metastatic cancer. The first patient had severe upper lim b pain and lymphedema secondary to breast carcinoma, and the second pa tient had an acutely ischemic leg secondary to pelvic obstruction from an ovarian tumor. The goal of treatment was to relieve the pain, whic h was resistant to opioid drugs, and to optimize the quality of life t hat remained, estimated to be only a few weeks. Methods. The first pat ient received a continuous brachial plexus block via an epidural cathe ter, introduced by means of a Tuohy needle and a peripheral nerve stim ulator to locate the plexus accurately. The second patient required ca theterization of both the sciatic and femoral nerves, again with a per ipheral nerve stimulator used to locate the nerves prior to inserting the catheters. Results. Analgesia was established with a bolus of loca l anesthetic and maintained with a continuous infusion of local anesth etic in the first patient. For the second patient, fentanyl was added to the local anesthetic, as it had been shown to improve analgesia in the lower limb in previous work. Ln the first patient, the analgesia a llowed active treatment of the lymphedema and mobilization of the limb , and she remained pain free until her death 2 weeks later. In the sec ond patient, the infusions controlled the pain both before and after s urgical amputation of the limb, until the stump was well healed. Concl usions. Peripheral nerve catheterization proved beneficial in two pati ents who presented with difficult pain management problems and should be more widely considered for the relief of severe cancer-related pain in both the upper and lower limbs.