Epidural catheter elongated through subcutaneous tunnel from the puncture site to the frontal abdominal wall in terminally ill cancer patients: a report of 3 cases

ABSTRACT

Continuous epidural injection of opioid/local anesthetic drugs can be a useful tool to alleviate intractable pain in cancer patients. The use of an epidural catheter, however, always faces with contamination and infection. In order to avoid contamination, an injection port is often implanted in the subcutaneous space and intermittent or continuous injection is employed. The injection port requires an additional cost and a little more time for implantation. Both the cost and the time-requiring procedure may be of problem in the terminally ill cancer patients. We present 3 cases of cancer patients with high risk of catheter contamination treated with continuous epidural injection using catheters elongated through subcutaneous tunnel from the epidural puncture site to the front side of abdominal wall. The risk factors of the patients were; subcutaneous emphysema due to intestinal perforation in a 81 yr male with bladder cancer, local abscess and MRSA infection in a 45 yr female with uterine cancer, and cutaneous tissue disruption in a 51 yr female with lung cancer and multiple metastasis. The duration of epidural analgesia were 22, 26, and 21 days until the patient's death, respectively. Although the risk of epidural catheter contamination and infection was extremely high in all three patients, continuous epidural injection for more than 3 weeks was possible with favorable analgesic effects. Use of an epidural catheter elongated through subcutaneous route from the puncture site to the frontal abdominal wall offers a practical and inexpensive way in patients with intractable pain at least for a few weeks. Palliat Care Res 2011; 6(2) 350-357