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Abstract
Forty-six permanent epidural catheters and life-port units were implanted in 43 patients with severe, recurrent low back pain who had been considered not to be candidates for surgical intervention and in whom other therapeutic modalities had failed. Eight cases developed epidural fibrosis (EF). For analgesia, patients received either infusions with preservative-free solutions of fentanyl and bupivacaine or daily boluses of morphine and bupivacaine. Catheters remained from 75 days to 433 days. Signs of EF appeared from 21 days to 320 days after implantation. Pain at injection or resistance to injection were initial manifestations of EF, followed by poor, and eventually, nil analgesic effect. The epidural catheters were made of either polyamide, silicone, or polyurethane. Epidurograms revealed encapsulation, narrowing, and loculation of epidural space with gradually reduced spread of the contrast material. The occurrence of EF limits the permanency of implanted epidural catheters. The infusate does not cause this complication, which appears to be a foreign body reaction due to the presence of the catheter in the epidural space.
Keywords
References
- Long-term spinal administration of morphine in cancer and non-cancer pain: a retrospective study.Pain. 1991; 44: 215-220
- Technical complications during long-term spinal administration of morphine in terminally ill cancer patients: a review of 140 patients.Reg Anesth. 1991; 16: 208-213
- The rational use of intrathecal and extradural opioids.Br J Anaesth. 1989; 63: 165-188
- Sufentanil citrate and morphine-bupivacaine as alternative agents in chronic epidural infections for intractable non-cancer pain.Neurosurgery. 1991; 29: 36-46
- CT contrast evidence of injectate encapsulation after long-term epidural administration.Pain. 1992; 49: 369-371
- Histopathologic changes induced in the epidural space and central neural elements of the guinea pig during chronic epidural morphine administration.Reg Anesth. 1985; 10: 45-46
- Leakage of fluid administered epidurally to rats into subcutaneous tissue.Pain. 1991; 10: 45-46
- Long-term epidural bupivacaine in pigs.Acta Anaesthesiol Scand. 1985; 20 (suppl): 1-114
- Tissue reaction of morphine applied to the epidural space of dogs.Can Anaesth Soc J. 1984; 31: 268-271
- Epidural injections of bupivacaine, morphine, fentanyl, lofentanyl and DADL in chronically implanted rats: a pharmacological and pathologic study.Anesthesiology. 1986; 64: 43-46
- Post-mortem findings after epidural anesthesia.Anesthesiology. 1990; 45: 357-361
- Neuropathologic observations in cancer pain patients receiving chronic spinal analgesics.Schermz-Pain-Douleur. 1985; 6: 116-117
- Spinal cord compression during chronic epidural morphine administration in a cancer patient.Anaesthesia. 1987; 42: 1201-1203
- Fibrous mass complicating epidural morphine infusion.Neurosurgery. 1985; 16: 68-70
- Long-term epidural tissue reaction to three different catheter materials [abst].Reg Anesth. 1994; 19: 81
- Unilateral and bilateral partial laminectomy in lumbar disc prolapse: a follow-up study of 156 patients.Acta Orthop Scand. 1977; 48: 41-46
- Segmented polyurethane: a polyethyl polymer: two years experience.J Biomed Mater Res. 1971; 5: 373-387
- Nonmalignant intractable pain treated with temporary epidural infusions of analgesics at patient's domicile [abst].Reg Anesth. 1994; 19: 81
- Cervical radiculopathy treated by infusion of epidural analgesics in homebound patients.J Clin Anesth. 1994; 6: 33-36
Article info
Publication history
Accepted:
March 3,
1995
Identification
Copyright
© 1995 Published by Elsevier Inc.
