Akademik Veri Yönetim Sistemi
5th International Pain Istanbul Symposium Hands on Cadaver Course, İstanbul, Türkiye, 21 Ekim 2022
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Presentation Options
Abstract
Topics: Cancer and Palliative Care, Treatment Approaches: Interventional
Presentation
type: Oral presentation
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Presenting Author Contact Details
Institution(s):
Gazi University Faculty of Medicine / Algology Department / Ankara / Turkey
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Co-Author(s) Contact Details
Author(s):
Gözde Çelik, Ahmet Cemal Kaya, Didem Tuba Akçalı, Avni Babacan
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Abstract Title
Epidural
hyaluronidase administration for painful epidural port injection
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Abstract
Background
Management
of widespread abdominal pain due to cancer is one of the most challenging problems
in pain medicine. Epidural drug delivery catheter malfunctions are a principal cause
of therapy interruption. In this case report; we present the treatment of a
patient with cancer pain during epidural port injection with hyaluronidase.
Methods:
In
this case report, a 53-year-old female patient with peritoneal carsinomatozis
had severe abdominal and back pain. Medical treatment consisting of 100 mcg
fentanil patch and 150 mg/day pregabalin was inefficient. An epidural port was
placed on the patient at the thoracic level, guided by fluoroscopy.
Three
months after the procedure, the patient started to complain of pain in his back
during the drug injection. It was thought that the pain might be due to
epidural fibrosis.
Epidural
steroid was administered to the patient, but there was no reduction in pain.
Afterwards, epidural hyaluronidase was applied to the patient. There was a
significant decrease in the patient's pain (VAS: decreased from 7 to 1). After
2 months, the injection pain started again, and the hyaluronidase injection was
re-administered and the patient again benefited.
Results
Epidural
catheters and port systems are beneficial for long term analgesia however there
are important complications such as painful epidural injection and epidural
fibrosis.
In
cases of painful epidural injection and epidural fibrosis, epidural steroid
injection is used to reduce pain.
Hyaluronidase
moves barrier between tissues by hydrolyzing glucosaminicbonds between
hyaluronicacid, a major inter cellular material, and connective tissues to
dissolve the bonds and relieve fibroplasia in tissues.
It
is also known that hyaluronidase acts to relieve swelling and edema in tissues.
Hyaluronidase
is being used to treat spinal stenosis and failed back / epidural adhesions in
algology.
In
this case, we tried fibrinolytic effect of hyaluronidase for epidural fibrosis.
Conclusions
We
concluded that epidural hyaluronidase can be an option when other methods have
failed in the treatment of injection pain in a cancer patient with an epidural
port.
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Keywords
Hyaluronidase,
Cancer Pain, Painful epidural injection
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