Neil Hilliard1, Stuart Brown2, Steve Mitchinson2. 1. End of Life Program, Fraser Health Authority, Abbotsford, BC, Canada Neil.Hilliard@fraserhealth.ca. 2. End of Life Program, Fraser Health Authority, Abbotsford, BC, Canada.
Abstract
BACKGROUND: This case report describes an end-stage cancer patient with intractable neuropathic pain and delirium who was successfully managed during the last 3 weeks of her life with a continuous subcutaneous infusion of dexmedetomidine. CASE PRESENTATION: A 55-year-old woman with locally advanced cervical cancer and uncontrolled pelvic pain was admitted to a tertiary palliative care unit for pain management. As her disease progressed, the patient's pelvic pain intensified despite treatment with methadone, gabapentin, ketamine, and hydromorphone administered by continuous subcutaneous infusion plus frequent breakthrough doses of hydromorphone and sufentanil. CASE MANAGEMENT: A continuous subcutaneous infusion of dexmedetomidine was started and titrated to achieve pain relief. CASE OUTCOME: The patient's pain and delirium cleared. The treatment was successful in fulfilling the patient's goal of care: not to be deeply and continuously sedated, but to be rousable and of clear mind while still having good pain control. CONCLUSION: Dexmedetomidine is a potentially useful medication for the targeted treatment of intractable pain and delirium in the tertiary palliative care environment. Future research is required to compare dexmedetomidine infusion to standard treatment with midazolam infusion for treatment of intractable symptoms in the palliative care environment.
BACKGROUND: This case report describes an end-stage cancer patient with intractable neuropathic pain and delirium who was successfully managed during the last 3 weeks of her life with a continuous subcutaneous infusion of dexmedetomidine. CASE PRESENTATION: A 55-year-old woman with locally advanced cervical cancer and uncontrolled pelvic pain was admitted to a tertiary palliative care unit for pain management. As her disease progressed, the patient's pelvic pain intensified despite treatment with methadone, gabapentin, ketamine, and hydromorphone administered by continuous subcutaneous infusion plus frequent breakthrough doses of hydromorphone and sufentanil. CASE MANAGEMENT: A continuous subcutaneous infusion of dexmedetomidine was started and titrated to achieve pain relief. CASE OUTCOME: The patient's pain and delirium cleared. The treatment was successful in fulfilling the patient's goal of care: not to be deeply and continuously sedated, but to be rousable and of clear mind while still having good pain control. CONCLUSION: Dexmedetomidine is a potentially useful medication for the targeted treatment of intractable pain and delirium in the tertiary palliative care environment. Future research is required to compare dexmedetomidine infusion to standard treatment with midazolam infusion for treatment of intractable symptoms in the palliative care environment.
Authors: Mary Weatherall; Riku Aantaa; Giorgio Conti; Chris Garratt; Pasi Pohjanjousi; Michael A Lewis; Nicholas Moore; Susana Perez-Gutthann Journal: Br J Clin Pharmacol Date: 2017-05-10 Impact factor: 4.335