Epidural fentanyl-bupivacaine infusion for management of pain in the Guillain-Barré syndrome.

Abstract

Epidural morphine with fentanyl has been used with some success to treat the pain associated with Guillain-Barré syndrome. This report describes a female with Guillain-Barré syndrome in which lower extremity and generalized positional pain failed to respond to conventional pain therapy. An epidural infusion of bupivacaine and fentanyl was used to treat her pain. A case report. An epidural infusion of 15 mg/hour bupivacaine and 75 micrograms/hour fentanyl produced good pain relief (visual analog scale decreased from 9 to 2) and allowed increased mobility. Over 24 days of treatment, the infusion requirements gradually increased, suggestive of tachyphylaxis. These patients sometimes fail to respond to conventional pain therapy and may require the expertise of an anesthesiologist to deliver epidural analgesics.