Challenges in the treatment of pain in children with cancer and tunneling of epidural catheter for long term infusion

The main differences of cancer pain in children from adults are predominance of tumor related pain, difficulties in pain assessment and rare use of regional blocks. A 2.5 years old girl with severe pain due to pelvic/sacro-cocygeal mass will be presented here. Pain assessment depended on the observations of other patients’ parents in the ward, because the child’s family was uncooperative. An epidural catheter was placed at T12-L1 level when the conventional methods were unsuccessful and tunneled 5 cm away from the insertion site. Infusion of bupivacain 0.2 mg/kg/hr + fentanyl 0.4 mg/kg/hr from the catheter provided pain relief. Another epidural catheter placed when intravenous morphine infusion (0.02 mg/kg/hr) became inefficient following accidental removal of the initial one. The patient was transferred to another hospital for chemotherapy on the 2nd week. The good interactions between the anesthesiologists accomplished the continuity of pain therapy. Tunneling epidural catheter is an invaluable technique in children who are resistant to conventional pain therapies.