Lumbar paravertebral blockade as intractable pain management method in palliative care.

摘要: Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative unsuccessful subcutaneous fentanyl a 71-year old patient pathological fracture femoral neck, bone metastases, and contraindications morphine. Bupivacaine continuous infusion (0.25%, 5 mL · hour(-1)) or boluses (10 0.125%-0.5% solution), used for lumbar PVB, resulted relief, decreased demand opioids, led better social interactions. The factors contributing increased risk systemic toxicity from LA were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; complex therapy possible drug-drug These were taken into consideration during treatment. Bupivacaine's side effects absent. Coadministered drugs could mask LA's toxicity. Elevated plasma α1-acid glycoprotein levels protective factor. To evaluate benefit-risk ratio PVB treatment constant infusion, bupivacaine serum determined drug half-lives calculated. elimination was slower when administered than (t½ = 7.80 hours versus 2.64 hours). Total concentrations remained within safe ranges whole course (22.9-927.4 ng mL(-1)). In case presented, (≤ 137.5 mg 24 hours(-1)) easy perform, safe, effective method control. (≤150 12 had acceptable risk-benefits ratio, but ineffective.