Propofol as an Adjuvant in the Treatment of Cancer - Related Pain

Han, Tae Hyung; Hwang, Won Gyoon

Abstract

Cancer is a devastating disease, and the treatment of related pain is an extremely challenging task. Providing adequate analgesia while avoiding unnecessary drug effects often requires a polypharmacologic approach in cancer pain management. A 36-year old woman with breast cancer metastatic to the axial skeleton and bilateral hip joints was admitted to hemato-oncology service with complaints of intractable abdominal and hip pain. Despite rapidly increasing doses of intravenous morphine up to 350 mg per day; transderma1 fentanyl; midazolam; ketorolac; lorazepam; dexamethasone, the patient continued to describe her pain as 10 of 10, refusing all surgical /diagnostic interventions not directly related to pain control. She did, however, consent to lumbar epidural catheter placement. The patient was sedated with titrating doses of propofol to assist with positioning. Even though the procedure was not successful due to significant thoracolumbar scoliosis, the patient admitted feeling better than she has in months during attempted placement. After continuous infusion of propofol was initiated at subhypnotic dose, the patients analgesic demand was drastically reduced and described her pain as ""1 to 3"" of ""l0"". Approximately 96 hours after the propofol infusion was started, the patient expired comfortably. There had been no change in her medical regimen during final 48 hours. In the case described, propofol was extremely advantageous as an adjuvant in the management of cancer related pain.