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Anesth Analg 2003;97:1740-1742
© 2003 International Anesthesia Research Society

PAIN MEDICINE

Epidural Analgesia at End of Life: Facing Empirical Contraindications

Hans Juha Exner, MD*, Jürgen Peters, MD{dagger}, and Matthias Eikermann, MD{dagger}

*Keski-Suomen Saivaanhoitopiiri, Anestesiologia ja tehohoito, Jyväskylä, Finland; and {dagger}Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany

Address correspondence and reprint requests to Dr. med. Matthias Eikermann, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstr. 55, D-45122 Essen, FRG. Address email to matthias.eikermann{at}uni-essen.de

In a patient with unbearable cancer pain at the end of life, long-lasting analgesia without impairment of consciousness could only be achieved with an epidural infusion of local anesthetics combined with opioids and clonidine. Despite leptomeningeal infection during prolonged treatment, epidural analgesia at the lumbar level provided analgesia using very large doses of local anesthetics combined with clonidine and morphine. Thus, terminal sedation was avoided, allowing the patient’s end-of-life planning of an "aware" death surrounded by her family. It may be useful to reconsider institutional pain management standards when unbearable pain occurs in patients with limited life expectancy.

IMPLICATIONS: We report a patient with severe visceral and neurogenic pain from metastatic carcinoma of the colon resistant to multimodal oral analgesic therapy. Although there were empirical contraindications, epidural analgesia was successful, allowing the patient’s end-of-life planning of an "aware" death surrounded by the family.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2003 by the International Anesthesia Research Society.