Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Sep 2017
Continuous Intravenous Lidocaine Infusion for the Management of Pain Uncontrolled by Opioid Medications.
Limited data exist describing the outcomes of patients receiving continuous lidocaine infusions. The objective of this study was to evaluate the effect of use of continuous lidocaine infusions for pain management at a community teaching hospital. A retrospective chart review was performed that included adult patients receiving continuous systemic lidocaine infusions for the treatment of pain. ⋯ Similarly, a difference was present comparing morphine equivalent usage on day -2 with day +2 (P = .008) and day -1 with day +1 (P = .006). Continuous infusions of systemic lidocaine appear to be beneficial in some patients experiencing uncontrolled pain and may improve pain scores while decreasing opioid requirements. Overall beneficial effects of systemic lidocaine may last longer than the infusion itself.
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J Pain Palliat Care Pharmacother · Sep 2017
Case ReportsPropofol-Based Palliative Sedation to Treat Antipsychotic-Resistant Agitated Delirium.
Delirium is a common problem in terminally ill patients that is associated with significant distress and, hence, considered a palliative care emergency. The three subtypes of delirium are hyperactive, hypoactive, and mixed, depending on the level of psychomotor activity and arousal disturbance. When agitated delirium becomes refractory in the setting of imminent dying, the agitation may be so severe that palliative sedation (PS) is required. ⋯ These characteristics make it relatively easy to titrate. Reported doses range from 50 to 70 mg per hour. The authors present a case of antipsychotic-resistant agitated delirium treated with a propofol intravenous infusion.
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J Pain Palliat Care Pharmacother · Jun 2017
Case ReportsIntrathecal Injection of Gadobutrol: A Tale of Caution.
In the field of interventional pain medicine a radiocontrast agent is commonly used in conjunction with fluoroscopy. Limited work has been published regarding the use of gadolium based contrast agents (GBCA) in the intrathecal space. We report a case of an intrathecal gadobutrol injection resulting in neurotoxic manifestations. ⋯ Less than five minutes after the injection of gadobutrol, the patient reported spastic pain of the lower extremities. There is a lack of evidence as it relates to the use of GBCA specifically gadobutrol in the intrathecal space. The use of gadobutrol in the intrathecal space should be used with caution.
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J Pain Palliat Care Pharmacother · Jun 2017
Case ReportsPain Management of Malignant Psoas Syndrome Under Epidural Analgesia During Palliative Radiotherapy.
Malignant psoas syndrome is a rare malignant condition presenting as lumbosacral plexopathy and painful fixed flexion of the hip. Metastasis to the psoas muscle is observed, which damages the nerve bundles in the lumbosacral plexuses. The syndrome presents as refractory lower back pain with several other neurological symptoms. ⋯ By epidural analgesia, he could remain in supine position and complete radiotherapy without increasing opioid administration. His back pain was improved after the radiotherapy. Epidural analgesia is an effective treatment choice for a patient who is unable to keep the position during palliative radiotherapy.
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Palliative care provides holistic care to individuals in life-threatening or life-limiting conditions. This narrative describes the journey of Kanchan. A strong lady and a doting mother, she came to the hospital by choice, in immense pain and with swelling. ⋯ Kanchan was able to benefit from physiotherapy to reduce the risk of lymphoedema after surgery for breast cancer. Her narrative illustrates how she found comfort and relief, ably supported by the dedicated hospital team. Although a chance encounter led her to the hospital, her story emphasizes the need for greater awareness about palliative services to ensure early intervention.