Intrathecal Catheter Tip Inflammatory Mass: A Failure of Clonidine to Protect

Polyanalgesic Consensus Conference 2007: Recommendations for the Management of Pain by Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel

“…As of this writing, there have been at least three reports published in the literature of baclofen‐related IT granulomas (178,180,181). Even though the literature suggests a granuloma protective effect of clonidine (24,182), there have been reports of patients with IT clonidine, alone, or in combination with other IT agents developing granulomas (23,183). Patients receiving therapies containing clonidine also should be evaluated for granulomas.…”

“…The toxicity of IT morphine has been addressed in earlier studies demonstrating a causal association between IT morphine sulfate infusion and the formation of catheter‐tip granuloma in beagle dog and sheep models at doses as low as 1.5 and 12 mg/day, respectively (20,21). Magnetic resonance imaging (MRI) and histopathologic analysis reveal that the formation of catheter‐tip inflammatory masses in dogs is dependent on IT morphine sulfate local concentration rather than dose (22,23). Chronic intrathecal morphine at doses of 9 or 12 mg/day produced allodynia in beagle dogs shortly after infusion commenced, a concentration‐dependent increase in hind limb dysfunction during the course of the infusion (24) and spastic paraparesis at a dose of (30 µg) after 6 min of aortic occlusion in rats (25).…”

Increased Spasticity From a Fracture in the Baclofen Catheter Caused by Charcot Spine: Case Report

“…The use of intrathecal opioid and nonopioid medications has been associated with the development of catheter granulomas, which occur with a frequency of 0.1% to 5%, [20][21][22][23][24] as it did in this case, most likely because of shearing and inflammation at the Charcot level. It has been postulated that the use of intrathecal medication can ultimately lead to spinal deformity and instability over time.…”

Case Scenario: Self-extraction of Intrathecal Pump Medication with a Concomitant Intrathecal Granulomatous Mass

“…27 Contraction, reduction, or disappearance of masses has been described on follow-up imaging studies after an interval of 2-5 months. 22,27,31 Substantial decrement of the intrathecal mass seen on imaging studies is necessary before resumption of intrathecal treatment should be considered. In addition, treatment options include removal of the catheter and placement of a new catheter under monitored anesthesia care at the time of removal or at a later date.…”

“…17 Clonidine has been described as having protective properties with respect to inflammatory mass formation, 18,22 but it has also been reported to fail in protection against inflammatory mass events. 31 Nevertheless, if morphine is the agent of choice, clonidine may present synergistic analgesic effects, thus allowing a lower dose of morphine through the course of treatment. Alternatively, hydromorphone can be delivered to the intrathecal space and may have advantages over morphine because it is a significantly more potent analgesic than morphine.…”