The terminal stage of oncological diseases may be accompanied by insatiable pain. Even such doses of drugs, from which the patient can not just stand up — it’s good to ask for a vessel, can not completely eliminate the pain. Not every young and healthy person understands what “quality of life” is for cancer patients. But the one who worked with them knows — everyone wants to see how the sun rises tomorrow. And preferably, without unbearable torment. There is a lot of work for young and even inexperienced enthusiasts in this almost tilled field, for the old and experienced are not in a hurry here.
Regional (including epidural) analgesia makes it possible to eliminate even opioid-resistant pain. At the same time, not only the consciousness of the patient is preserved, but sometimes even the ability to walk and cater for themselves. To avoid the motor and sympathetic block, it is better to introduce not local anesthetics, but opioids.
Doses of opioids, especially if tolerance to them has already developed, is sometimes difficult to calculate. The benchmark — the first epidural dose should be about ten times less than the last intravenous dose.
An epidural catheter will provide an opportunity not only to re-anesthetize, but also to select a dose.
A bacterial filter that has long been available to us will protect the lumen of the catheter from infection for many days, even at home. But with such a long stay of the catheter, besides “fidgeting” back and forth, the penetration of the infection on its outer surface is very likely.
Tunneling of the catheter, that is, removing it under the skin to a distant (and even less contaminated) place, significantly reduces the risk of catheter displacement and external infection. To do this, even before the epididuminal puncture, a small incision is made in the place chosen for it (! -Th incision, fig. 93). Then, an epidural puncture is performed, a catheter is inserted, the epidural needle is removed and, making a needle distance to the side of the spine another incision (2nd incision, Fig. 93), the epidural needle is inserted through it to the first incision. Having inserted the catheter through the tip of the needle, pull out its outer end together with the needle until the loop of the catheter is hidden in the first incision (here the skin is sutured). So you can do one or two more times. Only the last time the needle is inserted without an incision, so that the catheter finally leaves not through an incision, but through a puncture (narrower “gateway” for infection). After this, a bacterial filter is attached to the catheter.