• Lana Ferguson and Matthew Wilson.
• Waikato Specialist Palliative Care Service, Waikato District Health Board, Hamilton, Waikato, New Zealand.
• Palliat Med. 2021 Sep 1; 35 (8): 1625-1628.

BackgroundThis report describes the use of intranasal dexmedetomidine to control incident pain and facilitate daily change of dressing in a patient with cutaneous breast cancer.Case PresentationA 45-year-old woman with extensive thoracic cutaneous metastatic bilateral breast cancer requiring daily 2-hour dressing changes to manage significant exudate. Pain during change of dressing was severe and unresponsive to usual analgesics. Deeper sedation was not an option as the patient was required to change position 1 hour into dressing change.Case ManagementIntranasal dexmedetomidine was administered 40 minutes prior to dressing change and provided effective rousable sedation and analgesia for the duration of the procedure.Case OutcomeDexmedetomidine provided rousable sedation, allowing the patient to follow commands and mobilise during the procedure. Pain was controlled. No adverse cardiovascular effects were noted with the use of intranasal dexmedetomidine.ConclusionIntranasal dexmedetomidine is a potentially useful medication for procedural sedation in the management of complex wound dressings. It provides rousable short-term sedation, anxiolysis and analgesia. Further research into the role of intranasal dexmedetomidine to facilitate challenging dressing changes in a community setting is warranted.

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