Epidural pain management in advanced gastric cancer with inoperable malignant bowel obstruction.

Autor:	Bohan R; Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA rbohan1@ufl.edu., Budweg J; Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA., Vose S; Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA., Sorin M; Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
Jazyk:	angličtina
Zdroj:	BMJ case reports [BMJ Case Rep] 2023 Jul 24; Vol. 16 (7). Date of Electronic Publication: 2023 Jul 24.
DOI:	10.1136/bcr-2022-253665
Abstrakt:	Presented is a case of a man in his 20s with gastric cancer with metastasis to a perineal nodule and the splenic flexure (previously resected due to acute bowel obstruction) who presented with prolonged, intermittent, inoperable bowel obstruction likely due to adhesions, exacerbated by functional ileus due to substantial opioid requirement. In an episode of obstruction during the described admission, the patient remained obstructed after more than 10 days of medical management. The patient suffered from intense abdominal distention and pain, necessitating hundreds of oral morphine equivalents daily. A ropivacaine thoracic epidural infusion was initiated, allowing decreased opioid use and relief of opioid-induced ileus contributing to his bowel obstruction. He subsequently had multiple formed bowel movements, which quickly decreased the patient's abdominal distention and immediate risk of perforation. This case explores epidurals as an underutilised approach to pain management in metastatic gastric malignancy and inoperable malignant bowel obstructions. Competing Interests: Competing interests: None declared. (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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