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Case report: bilateral tunneled epidural catheters to prevent unilateral analgesia for cancer-related pain

Authors Padalia RB, Reeves CJ, Shah N, Patel AA, Padalia DM

Received 28 February 2017

Accepted for publication 31 May 2017

Published 20 July 2017 Volume 2017:10 Pages 79—82


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Stefan Wirz

Raj B Padalia,1 Corey J Reeves,2 Neal Shah,1 Ankur A Patel,3 Devang M Padalia4

1Pain Medicine, University of South Florida, Tampa, FL, USA; 2Physical Medicine and Rehabilitation, University of South Florida, Tampa, FL, USA; 3Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA; 4Interventional Pain, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA

Objective: Unilateral analgesia often occurs with epidural analgesia. Traditional methods of troubleshooting this problem can be insufficient in obtaining adequate pain relief in a timely manner for terminal cancer patients. This case report demonstrates a safe and effective solution which can be utilized in these circumstances.
Case report: A 55-year-old female with stage IV pancreatic cancer and life expectancy of a few weeks presented to the interventional pain clinic with intractable sacral pain. The decision to place an epidural catheter and external pump for analgesia was made. An epidural catheter placed at the L5-S1 level showed contrast spread only along the right nerve roots and a test dose produced only right-sided analgesia. Suspecting compartmentalization of the epidural space, a second left-sided epidural catheter was placed and bilateral analgesia was achieved by using both catheters. This dual catheter technique gave the patient effective bilateral analgesia until she passed away several weeks later.
Conclusion: The bilateral epidural catheter technique is safe and effective in patients who present with persistent unilateral epidural analgesia despite exhausting traditional solutions.

Keywords: pain management, palliative care, cancer, regional techniques

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