Positive effect of regional analgesia (RA) in terminal stage paediatric chondrosarcoma: a case report and the review of the literature

A 10-year-old girl was treated for progressive left pelvic chondrosarcoma a nd severe local pain radiating to the ipsilateral lower extremity. Despite high doses of opioids, pain was poorly controlled and treatment resulted in urine retention and constipation. Positive effect on pain (143 out of 181 days) was obtained by regional analgesia. Continuous lumbar epidural opioid infusion led to pain relief and disappearance of symptoms. Port-catheter d ysfunction necessitated a change of epidural catheter and the patient was t reated that with morphine, bupivacaine and clonidine plus clonazepam which resulted in relief of constipation and restoration of urinary function. The patient subsequently developed an abscess required or subarachoid infusion (morphine associated with clonazepam, clomipramine and corticosteroids). L ater bilateral controlateral cordotomy was performed due to absence of anal gesia and the patient subsequently died of tumour progression. (C) 1999 Int ernational Association for the Study of Pain. Published by Elsevier Science B.V.