Continuous Intrathecal Meperidine via an Implantable Infusion Pump for Chronic, Nonmalignant Pain

Abstract

Continuous intrathecal meperidine via an implantable infusion pump may be an effective alternative in the treatment of chronic pain.

Spinal drug delivery

“…Although 82% of patients found that their ability to perform the activities of daily living improved, 3.8% reported a decrease in this indicator. Analysis of dosage by diagnosis revealed that dosing was significantly Onofrio et al [4] Morphine µ opioid Cancer Hassenbusch et al [5] Neuropathic Anderson and Burchiel [6] Benign Goodman and Brisman [7] CRPS Coombs et al [8] Hydromorphone µ opioid Cancer Harvey et al [9] Meperidine µ opioid Benign Max et al [10] Methadone µ opioid Cancer Meignier et al [11] Fentanyl µ opioid Cancer Devulder [12] Sufentanil µ opioid Neuropathic Oyama et al [13] β-endorphin µ opioid Cancer Moulin et al [14] DADL δ opioid Cancer Wen et al [15] Dynorphin κ opioid Cancer Schoeffler et al [16] Midazolam GABA-A agonist Cancer Borg and Krijnen [17] Benign Zuniga et al [18••] Baclofen GABA-B agonist Neuropathic Tumber et al [19] Clonidine α-2 adrenergic Cancer Siddall et al [21] Neuropathic Eisenach et al [22] Experimental Borg and Krijnen [17] Benign Sjoberg et al [23] Bupivacaine Na + channel antagonist Cancer Nitescu et al [24] Benign Penn and Paice [25] Ziconotide Ca ++ channel antagonist Cancer Brose et al [26•] Neuropathic Staats et al [27] Yang et al [28] Ketamine NMDA antagonist Cancer Kristensen et al [29] CPP NMDA antagonist Neuropathic Penn [30] Octreotide Somatostatin Cancer Paice et al [31] Benign Karlesten and Gordh Jr [32] R-PIA Adenosine analogue Neuropathic Klamt et al [33] Neostigmine AChase inhibitor Cancer Devoghel [34] Aspirin COX inhibitor Cancer Pellerin et al [35] Benign COX-cyclooxygenase; CPP-3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid; CRPS-complex regional pain syndrome; DADL-[D-Ala2,D-Leu5]-enkephalin; GABA-gamma-aminobutyric acid; NMDA-N-methyl-D-aspartate; R-PIA-R-phenylisopropyl-adenosine.…”

“…These include ␤-endorphin, hydromorphone, meperidine, methadone, fentanyl, and sufentanil [8][9][10][11][12]13]. With the exception of ␤-endorphin, physicians routinely substitute these agents for morphine when the drugconcentrating ability of morphine precludes a further increase in the volume of the dose.…”

Evidence-Based Review of the Literature on Intrathecal Delivery of Pain Medication

“…133,146 Meperidine There has been little information published on the use of intraspinal meperidine in the treatment of pain. [153][154][155][156][157][158] Meperidine is a synthetic phenylpiperidine structure with local anesthetic-like effects. It is capable of both sensory and motor blockade, and its local anesthetic-like effect is not blocked or reversed by naloxone.…”

“…There is one case report of the intrathecal infusion of meperidine that showed no evidence of toxicity or adverse effects long term. 158 Potential advantages of meperidine include its combined opioid and local anesthetic properties, intermediate lipid solubility, and stability at 100 and 200 mg/cc concentrations. In limited cases, there has been no overt toxicity, and use of meperidine having a pH near 4.0 did not appear to affect pump performance.…”

Rationale and Technique for Single and Multiple Drug Combinations in Long‐term Intrathecal Infusions

“…It has been found to produce both motor and sensory block, which is not reversed by the administration of naloxone. It has intermediate lipid solubility which compared to morphine would cause less cephalad spread but a faster elimination from the CSF 43 . The possible accumulation of normeperidine may limit its long‐term intrathecal use 42 .…”