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Continuous tunnelled femoral nerve block for palliative care of a patient with metastatic osteosarcoma

Division of Anesthesia, St. Jude Children's Research Hospital, Memphis, Tennessee, USA

Summary

An 18-year-old man with metastatic femoral osteosarcoma had inadequate pain control with gabapentin, naproxen and intravenous fentanyl. A tunnelled femoral nerve catheter was used to administer a continuous infusion of 0.2% ropivacaine and 4 µg/ml clonidine (10 ml/hour) until his death 88 days later. During discharge from hospital, catheter disconnection resulted in severe pain and readmission. Tunnelling, aseptic insertion technique, antibiotics and sterile infusate prepared by the pharmacy may have reduced the chance of infection. We propose that this is a suitable and effective technique in the long-term management of patients with terminal cancer and should be considered on a case-by-case basis.

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