Abstract
We report a patient whose cancer pain in the upper limb was refractory to oral and transdermal opioids and was treated with continuous epidural and brachial plexus block by implanted port. A man aged in his 50s had pain in the upper limb due to pulmonary sulcus cancer. The pain was not relieved by oral or trandermal opioids. An epidural catheter was inserted via C6/7 intervertebral space and continuous infusion of 0.2% ropivacaine with morphine was begun. This strategy relieved the pain. Reinsertion of an epidural catheter was attempted 1 month after continuous epidural block. The catheter was embedded subcutaneously and a port was also fixed into left-sided anterior chest wall just beneath the breast. Continuous infusion of 0.2% ropivacaine with morphine gave almost the same pain relief as the epidural block. CT scan revealed that the catheter tip was located in the ipsilateral brachial plexus to the painful upper limb, instead of epidural space. The pain was controlled until his death 4 weeks after reinsertion of the catheter.
