• Eric Buchser, Anne Durrer, Dominique Chédel, and Jean-Pierre Mustaki.
• Anaesthesia and Pain Management Services, Centre for Neuromodulation, EHC, Hospital of Morges, Morges, Switzerland. eric.buchser@hospvd.ch
• Pain Med. 2004 Sep 1;5(3):248-52.

AbstractWe present two cases of cancer patients with intractable mechanical and visceral pain that was unrelieved with either comprehensive medical management or intrathecal morphine who received intrathecal bupivacaine. While the continuous administration of a seemingly significant daily dose neither relieved pain nor caused measurable clinical changes, the addition of small, presumably negligible bolus doses on top of the continuous infusion resulted in spectacular pain control, clear thermoanalgesic suspended block, and in one of the patients, significant hypotension. To the best of our knowledge, such an observation has neither been reported before nor can we provide a satisfactory explanation for it. However, we believe it may have significant implications for the treatment of some patients, in particular, cancer patients with mechanical pain that cannot be adequately relieved with morphine whatever the route of administration.

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