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Iqra Kanwal-Akram-Muhammad 1, Vicente Moreno Rodríguez 1, Alberto Abad-Pérez 1, Alejandra Mira-Puerto 1
1 Servicio Anestesiología y Reanimación y Clínica del Dolor, Hospital Universitario Sant Joan, Reus, Barcelona, España
*Correspondence: Iqra Kanwal-Akram-Muhammad. Email: iqra.k.bibi@gmail.com
37-year-old woman with advanced breast cancer in palliative care, with supraclavicular adenopathic progression causing severe neuropathic pain in the left upper extremity (visual analog scale (VAS) 10/10) due to compression of the brachial plexus. She was admitted for poor pain control despite intensive treatment with major opioids and neuromodulators. Interscalene catheter was placed under ultrasound control and neurostimulation. Initial infusion of 8 ml of lidocaine 2% and maintenance with ropivacaine 0.2% + fentanyl (2 mcg/ml) at 2 ml/h, combined with an intravenous infusion of ketamine at 0.1 mg/kg/h. The multimodal approach offers a valuable therapeutic alternative in the palliative care setting. In this case, placement of an interscalene catheter with continuous infusion of local anesthetic and opioids in combination with intravenous ketamine infusion allowed effective pain management (VAS 2/10), reducing the need for major opioids and significantly improving the patient’s well-being.
Content available only in Spanish.
