Continuous Infusion of Opioid and Bupivacaine by Externalized Intrathecal Catheters in Long-Term Treatment of "Refractory" Nonmalignant Pain

Abstract

During the intrathecal period [range, 3-1,706 days; median, 60 days; totaling 14,686 days, 7,460 (50% of which were spent at home)], 86 patients (approximately 95%) obtained acceptable (60-100%) pain relief. The nocturnal sleep duration increased from <4 to 7 hours (median values), nonopioid analgesic and sedative daily consumption became approximately two times lower, whereas the gait ability and ambulation patterns remained practically unchanged. Five patients still had ongoing treatment after durations of 30 to 1,707 (median, 206) days at the close of the study. In the remaining 85 patients, the intrathecal treatment was terminated because of patients' death (n = 23), replacement of the intrathecal treatment by dorsal column stimulation (n = 1), pain resolution (n = 32), refusal to continue the intrathecal treatment (n = 19), lack of cooperation due to delirium or to manipulation of the pump (n = 8), and loss of efficacy of the intrathecal treatment (n = 2). Thus, in the long run, the intrathecal treatment failed in 29 of the 85 patients with terminated treatment (34%). The principal side-effects and complications, except those attributed to the dural puncture, the equipment, and the long-term catheterization of the subarachnoid space, which are presented separately, were severe bradypnea (n = 1), transient paresthesiae (n = 26), short-lasting pareses (n = 16), temporary urine retention (n = 34), episodic orthostatic arterial hypotension (n = 11), and attempted suicide (n = 5, 3 of which were successful). No neurologic sequelae or death could be attributed to the intrathecal procedure. (ABSTRACT TRUNCATED)

Is Once Failed Back Surgery, Always Failed Back Surgery? A Relative Success of Surgical Intervention in a Patient with Failed Back Surgery on Intrathecal Morphine Pump

“…Even in the presence of such device, co-medication with one or combination of different classes of analgesics may still be necessary. A favourable result and a satisfactory pain control is then expected for approximately 60-95% of these patients [6][7][8][9][10].…”

The Cerebrospinal Fluid in Severe Pain Conditions : Clinical, Pharmacological and Proteomic Aspects

“…In Sweden, the infusion of a combination of morphine and bupivacaine via an externalized catheter has been studied extensively by a group in Gothenburg, both for cancer pain [172,219,220] and non-cancer pain [62,171]. Bupivacaine can also be used as the sole agent for ITA [61,67,142].…”

Zoster-Associated Pain and Post Herpetic Neuralgia

“…Furthermore, the value of epidural injections for the treatment of existing PHN has not been evaluated (van Wijck et al, 2010). Continuous infusions of analgesic agents (typically an opioid or local anesthetic) via an externalized intrathecal catheter or internalized intrathecal pump may also be used for the treatment of PHN, although no controlled trials examining the analgesic efficacy of these modalities are available (Angel et al, 1998;Nitescu et al, 1998). In extreme cases, refractory to all treatment options, other interventional strategies were described in the literature.…”