Acute pain in advanced cancer: An opioid dosing strategy and illustration

Continuous Erector Spinae Plane Block for Refractory Chest Wall Pain in a Patient With Metastatic Breast Cancer: A Case Report

In this case report, we described the use of the continuous erector spinae plane (ESP) block in a patient presenting with severe chest wall pain due to terminal metastatic breast cancer. Her pain was refractory to most treatment modalities despite being on huge doses of parenteral opioids for 6 months. A single shot ESP block was initially trialed, which provided her complete pain relief. This was followed by an ESP catheter insertion and continuous infusion of local anesthetic, which helped her wean off the parenteral opioids over the next 4 days. She was discharged home with the catheter in situ, attached to a delivery pump.

Effectiveness of rapid titration with intravenous administration of oxycodone injection in advanced cancer patients with severe pain

Some cancer patients suddenly develop severe, excruciating pain that requires rapid management using opioid medication. This study aimed to evaluate the effectiveness of rapid titration using oxycodone injection. Study subjects were advanced cancer patients who experienced severe pain (numeric rating scale ≥7) and needed prompt pain relief. Primary endpoint was (i) time required for the initial sign of significant analgesia to become evident. Secondary endpoints were (ii) pain relief stabilization success rate and (iii) adverse effects. Groups treated with oxycodone (oxycodone group) and morphine (morphine group) were retrospectively compared. The oxycodone group had 33 cases and the morphine group had 32 cases: (i) 15.6 ± 4.3 min in the oxycodone group and 19.3 ± 4.7 min in the morphine group (P = 0.001); (ii) 70 and 63% within 24 hours, and 88 and 84% within 48 hours in the oxycodone group and the morphine group, respectively (P = 0.36, 0.48). Although (iii) adverse effects appeared in both groups in the form of respiratory suppression, etc., the effects were mild. Rapid titration using oxycodone injections may be considered a beneficial choice.

Successful treatment of refractory cancer pain with morphine and ropivacaine: A case report

RATIONALE

Pain is one of the most common and distressing symptoms experienced by cancer patients. Cancer pain is a complex phenomenon with physical, psychological, social, and cognitive domains. Although opioids remain a cornerstone of cancer pain management, they are not effective in all patients. This case highlights the successful treatment of an opioid-refractory severe cancer pain crisis with ropivacaine infusion and subsequent rapid tapering of opioid dose.

PATIENT CONCERNS

This report illustrates the use of ropivacaine for cancer pain. A 62-year-old man with metastatic lung cancer was admitted to the hospital with uncontrolled chest-back and abdominal pain.

DIAGNOSES

The patient was diagnosed as refractory cancer pain.

INTERVENTIONS

Successful treatment with morphine and ropivacaine was performed to obtain longer opioid refractory severe cancer pain.

OUTCOMES

At 1, 3, and 6 months postoperative review, 70-75% relief of pain was achieved with overall activity was improved. The analgesic effect was stable during the 6-month follow-up period. No complications were reported during the follow-up period.

LESSONS

Our report demonstrates that ropivacaine is successful treatment for cancer pain in this case. It will supply us a novel navigation in cancer pain treatments. Meanwhile, this finding still needs additional study for confirmation.