This article describes the use and effectiveness of adjuvant propofol for pain control for pediatric oncology patients at the end of life. All patients experienced severe pain and agitation, not well controlled by continuous infusion opioids and benzodiazepines. Upon starting propofol, most patients had a temporary stabilization in the dose of opioids with subjective improvement in pain control, increased alertness, and improved ability to interact. Propofol infusions were continued until death in most patients. Two patients received propofol infusions at home. Subsequent increases in opioids in 6 patients and propofol in all patients were required for optimal pain control. Adverse effects included agitation in 5 patients and hallucinations in 2, which were controllable with benzodiazepines. One patient developed severe tetany, requiring propofol interruption; propofol was successfully restarted at a lower dose with an adjuvant benzodiazepine. The authors conclude that propofol is a useful and tolerable adjuvant agent for pain management in pediatric oncology patients at the end of life. It is a useful adjuvant if pain is unresponsive to continuous infusion opioids or if rapidly escalating doses of opioids are required.
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