Regional blocks for pain control at the end of life in pediatric oncology

Abstract

BackgroundPain management at the end of life is a fundamental aspect of care and can improve patients' quality of life. Interventional approaches may be underutilized for pediatric cancer patients.ObjectiveTo describe a single institution's 10 years of experience with regional pain management at the end of life in pediatric oncology.MethodsA retrospective cohort study of 27 patients with pediatric cancer who died between April 2011 and December 2021 and received continuous nerve block (CNB) catheters or single-shot nerve blocks (SSBs) during their last three months of life. The type of blocks, analgesic efficacy, and palliative care involvement were evaluated.ResultsTwenty-two patients (81.5%) had solid tumor diagnoses, including carcinomas, sarcomas, and neuroblastoma. Most (59%) patients received CNB catheters, and 12 patients (44%) received SSBs for pain control. The mean pain score decreases for CNB catheters and SSBs after interventions were −2.5 and −2.8, respectively, on an 11-point scale. Decreases in opioid patient-controlled analgesia dosing requirements were noted in 56% of patients with CNB catheters; likewise, in 25% of patients with SSBs at 24 h and in 8% at 5 days after interventions. Nearly all patients had PC involvement and received care from pain specialists (96% and 93%, respectively). Twenty-three (85%) had physician orders for scope of treatment orders completed before death.ConclusionRegional pain control interventions can be effective and safe for relieving regional pain and suffering in dying children and young adults. The collaboration between palliative care and pain management specialists at the end of life can help alleviate suffering and improve quality of life.

Regional anesthesia for pain control in children with solid tumors—a review of case reports

“…Little is known about using continuous nerve blocks (CNB) at the end of life. The existing evidence show that considerable number of patients who received CNBs experienced significant reduction in mean pain scores as well as decrease in opioid requirements ( 55 ). Case series analysis done by Anghelescu and colleagues ( 42 ) has shown the use of epidural catheters as a pain control in patients suffering from rhabdomyosarcoma, neuroblastoma, osteosarcoma, and other types of solid mass tumors.…”

“…We summarize the data from this study, excluding young adult patients in Table 4 . The authors conclude that performing regional anesthesia at this stage is not only technically feasible, but also significantly improves the patient's quality of life ( 55 ).…”

“…Despite the limited number of publications that address continuous and single shot blocks for pain management in pediatric terminal cancer, their importance cannot be overstated ( 39 ). In a recent retrospective study, Cuviello A et al analyzed pediatric and young adult patients who received continuous or single-shot nerve blocks as part of regional pain management at the end of life ( 55 ). The patient cohort included twenty-seven patients, of whom twenty-two (81.5%) were diagnosed with solid tumors.…”

Multimodal Analgesia in Pediatric Cancer Pain Management: A Retrospective Single-Center Study

“…Cuviello et al investigated interventional approaches for pain control in pediatric oncology. They revealed that regional pain control interventions can effectively relieve pain related to pediatric cancer [ 22 ]. A study investigating epidural blocks in children with cancer suggested that a continuous catheter-delivered pain blockade contributes to analgesia and moderates opioid requirements.…”