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Volume: 32  Issue: 3  Year: 2020
 

Attention: These articles have been accepted for publication; however, this list does not indicate the order in which articles will be published. As new articles are accepted, the order displayed here will change.

Pain Management With Intrathecal Clonidine In Colon Cancer Patient With Opioid Hyperalgesia: Case Presentation [Ağrı]
Ağrı. 2014; 26(2): 93-96 | DOI: 10.5505/agri.2014.37233  

Pain Management With Intrathecal Clonidine In Colon Cancer Patient With Opioid Hyperalgesia: Case Presentation

Lütfiye Pirbudak1, Alper Sevinç2, Göktürk Maralcan3, Ertuğrul Kılıç1
1Gaziantep University Medical Faculty, Anesthesiology And Reanimation Department
2Gaziantep University Medical Faculty, Internal Medicine Department, Medical Oncology
3Gaziantep University Medical Faculty, General Surgery Department

Introduction: Hyperalgesia is normally an increase in the response to a painful stimulant. Opioid-induced hyperalgesia (OIH) is a situation frequently encountered in algology clinics. Its treatment is complicated and problematic and often requires alternative methods.
Case: A 45-kilogram, 40-year-old male patient had been diagnosed with stage IV colon cancer 2.5 years ago. He had used non-steroid antiinflammatory drugs (NSAIDs), opioid analgesics and steroid preparations casually for his increased pain without any monitoring for one year. He was admitted five times for pain control. In the last visit, he complained of severe abdominal, pubic and rectal pain (visual analogue scale [VAS] 8), which was unresponsive to epidural analgesic, and later presented to the algology clinic; he was sleep-deprived, restless and in a panic state. Intrathecal morphine (1 mg) was applied considering his opioid tolerance. Because of increased pain (VAS 8-9) one hour after surgery for abscess in the liver and peritonea, the patient was given intravenous dexketoprofen trometamol and diazem considering his OIH. Then, bolus dexmedetomidine (1 µg/kg) followed by dexmedetomidine infusion (0.2 µg/kg/h) was started. Three days later, diagnostic intrathecal clonidine (30 µg) was applied, and the patient’s complaints regressed. With the patient reporting relaxed pain (VAS 1-2) after 30 minutes, an intrathecal port was placed. Both cancer pain and OIH were controlled with clonidine 90 µg/day. He was more relaxed, and his pain was tolerable until his death.
Discussion-Conclusion: Intrathecal clonidine administration may be an effective method for the treatment of OIH.

Keywords: Cancer Pain, Opioids, Hyperalgesia, Clonidine


Opioid Hiperaljesi Olan Kolon Kanserli Hastada İntratekal Klonidin ile Ağrı Yönetimi: Olgu Sunumu

Lütfiye Pirbudak1, Alper Sevinç2, Göktürk Maralcan3, Ertuğrul Kılıç1
1Gaziantep Üniversitesi Tıp Fakültesi, Anesteziyoloji Ve Reanimasyon AD, Algoloji BD
2Gaziantep Üniversitesi Tıp Fakültesi, İç Hastalıkları AD, Medikal Oncoloji BD
3Gaziantep Üniversitesi Tıp Fakültesi, Genel Cerrahi AD

Giriş: Hiperaljezi normalde ağrılı olan uyarana karşı verilen cevabın artmasıdır. Opioid hiperaljezisi, genellikle morfinin çok yüksek dozlarda kullanılması sonucu görülmektedir.
Olgu: 40 yaşında, 45 kilogram ağırlığında erkek hastaya 2.5 yıl önce evre IV Kolon Ca tanısı konulmuş. Hasta son 1 yıl süresinde artan ağrıları için kontrolsüz ve gelişigüzel NSAII, opioid analjezikler ve steroid preperatları kullanmıştı. Ağrı kontrolü için beş kez başvurdu. Son kontrolde, epidural analjeziğe cevap vermeyen şiddetli abdominal, kasık, rektal ağrıları (VAS 8) olan hasta uykusuz, huzursuz ve panik halindeydi. Opioid toleransı düşünülerek hastaya intratekal 1 mg morfin uygulandı. İşlem sonrası bir saat içinde giderek artan ağrıları (VAS 8-9) olması nedeniyle opioid hiperaljezisi (OIH) düşünülerek hastaya i.v. deksketoprofen, diazem verildi. Şikayetlerinde gerileme olmadı. Sonra i.v. bolus deksmedetomidin (1µg/kg) takiben deksmedetomidin infüzyonu (0.2 µg/kg/h) başlandı. Şikayetleri gerileyen hastaya 3 gün sonra diagnostik intratekal klonidin(30 µg) uygulandı, 30 dakika sonra ağrıları (VAS 1-2) rahatlayan hastaya intratekal port yerleştirildi. 90 µg/gün klonidin ile hem kanser ağrısı hem de OIH kontrol altına alındı. Hasta çok rahatladı, ağrısı ölünceye kadar dayanabilir düzeydeydi.

Tartışma-Sonuç: İntratekal klonidin uygulanması OIH tedavisinde etkili bir yöntem olabilir.

Anahtar Kelimeler: Kanser Ağrısı, Opioidler, Hiperaljezi, Klonidin


Lütfiye Pirbudak, Alper Sevinç, Göktürk Maralcan, Ertuğrul Kılıç. Pain Management With Intrathecal Clonidine In Colon Cancer Patient With Opioid Hyperalgesia: Case Presentation. Ağrı. 2014; 26(2): 93-96

Corresponding Author: Lütfiye Pirbudak, Türkiye


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