Long-term ambulatory continuous nerve blocks for terminally ill patients: a case series

Intolerable side effects and dissatisfactory pain control with traditional analgesics prompted the utilization of long-term, ambulatory, continuous peripheral nerve blocks (CPNBs) in terminally ill patients for palliative care.

Case series.

Continuous peripheral nerve catheters were placed in terminally ill patients in an ambulatory setting. The patients were managed at their homes, with nursing services available to manage the infusions and provide routine monitoring and care.

This is a case series of patients with severe peripheral pain and a terminal diagnosis in whom the goals of care were aimed at palliation. All three cases had an unfavorable coagulation status; case 2 had a prior pneumonectomy on the contralateral side and a large tumor on the ipsilateral lung of the continuous brachial plexus block.

Interventions included CPNBs, with infusion of local anesthetic. Specific techniques used include cervical paravertebral block and lumbar paravertebral block.

After infusion and titration of local anesthetic doses, oral opioid medication was significantly reduced, which resulted in an improved quality of life. The nerve blocks did not hasten death in any of the patients despite their coexisting conditions.

CPNBs are a reasonably effective modality to decrease opioid usage when side effects are undesirable for end-of-life care. The risk of unfavorable coagulation status, poor lung function, and risk of infection was outweighed by the benefit in this patient population.