REFRACTORY PAIN OF CHILDREN WITH CANCER - THE ROLE OF EPIDURAL ANALGESIA

Background. - Adequate treatment of pain in children with cancer is a critical issue, and is of equal importance as discussions concerning c hemotherapy, surgery and radiotherapy. Objective. - To evaluate the tr eatment of refractory pain by peridural analgesia. Methods. - Seven ch ildren (1-15 years) with solid tumors were treated with long term epid ural analgesia for refractory pain. Gatherers were inserted in epidura l space (L1-L2) and infused with sufentanil, bupivacaine and clonidine . Results. - Three out of five children with good response to peridura l therapy could be discharged. A 12-month-old infant had a poor respon se. Treatment was discontinued in a teenager boy because of patient re fusal. The side effects were: early catheter displacement in two patie nts and a bacterial contamination in one. Serious adverse effects rela ted to high doses of opiates were not observed However toxicity of bup ivacaine was observed in three patients leading to treatment discontin uation in one. Conclusion. - Long-term epidural analgesia looks promis ing in selected children with refractory pain. (C) 1998, Elsevier, Par is.