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ESRA19-0437 Pain on injection of epidural bolus doses in patient with chronic metastatic bone pain
  1. I Ivanovski,
  2. T Magdic-Turkovic,
  3. M Vucic and
  4. S Cosic
  1. Sestre Milosrdnice University Hospital Center, Department for Anesthesiology, Intensive Medicine and Pain Management, Zagreb, Croatia


Background and aims Pain during application of epidural therapy is described in literature but is very unspecific and uncommon.

Methods We are presenting a patient with bone metastasis of prostatic cancer who received epidural catheter after inability to control pain with alternative therapies. The patient was treated with continuous epidural therapy for 7 months. The patient had self-administered analgesics (bupivacaine + fentanyl) at home in form of intermittent boluses 3 times a day through the epidural catheter. The catheter itself and its insertion point had been changed every 3–4 weeks. Owing to the epidural analgesia, the patient was able to walk again, to avoid systemic analgesic effects and to cope with pain. Six months after application of epidural catheter patient started to feel pain during the application of epidural bolus doses. On all of the controls and catheter replacements the patient was afebrile and insertion point of the catheter was clear but he still felt pain during applications of epidural bolus doses. 10 days after last replacement of the catheter, patient was admitted to emergency department of our hospital with pneumonia, poor general condition, without adequate contact and with severe pain in the whole body. Epidural catheter was removed in emergency department because of inflammation and pus on the insertion point. Three days later patient had cardiorespiratory arrest with lethal outcome.

Results We discuss possible causes of pain during application of epidural anesthesia, primarily epidural abscess and catheter tip fibrosis.

Conclusions We could not give definite explanation for injection pain in our case because autopsy was not performed.

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