Case Study Report of Two Palliative Care Patients Receiving Intracerebroventricular (ICV) Analgesia
Faculty of Computing, Health and Science
School of Nursing, Midwifery and Postgraduate Medicine / WA Centre for Cancer and Palliative Care
This report describes two patients who received intracerebroventricular (ICV) analgesia via an Ommaya reservoir. These patients illustrate two reasons this pain relief approach might be offered- to improve both the quality and the quantity of life. Quality of life was the prime consideration in the case of the first patient, who was a young father with a 10-week-old child. His situation called for flexibility, privacy, and quality time at home with his wife and new daughter. The use of ICV analgesia for the second patient was motivated by a concern for both quality and quantity of life, because continued use of systemic opioids and adjuvant medications, at the doses required to achieve pain control, were causing increasing respiratory depression, confusion, and sedation. If an alternative approach was not found, the client might have died from pneumonia and respiratory failure. The procedure for this route of administration may be considered by many to be too invasive for palliative care patients. However, in instances when the patient rates his/her pain as unacceptable despite all other efforts, this approach may be warranted. Oral, subcutaneous, and transdermal forms of analgesia had been used and found ineffective for both patients prior to the decision to use ICV. Adjuvant medications in the form of anticonvulsants, antidepressants, and muscle relaxants had also been tried, but added to the sedative ill effects without providing relief.