Intrathecal Granuloma in Patients Receiving High-dose Intrathecal Morphine Therapy: A Report of Two Cases

Primary Hydromorphone-Related Intrathecal Catheter Tip Granulomas: Is There a Role for Dose and Concentration?

“…Since North et al reported the first granuloma formation in 1991 , there have been many articles describing inflammatory mass lesions at the tips of intrathecal catheters, mostly in the form of case reports or case series . Intrathecal catheter tip granulomas have been reported to occur at a rate of 0.5–3% of cases, though these numbers are believed to be conservative estimates of the actual prevalence .…”

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

“…Continuous IT morphine treatment is associated with inadequate pain relief or intolerable side‐effects in 10–15% of patients receiving this therapy (37). Other adverse effects that may result from in IT morphine infusion in high‐concentration include the potential for granuloma formation (37–47) and increased noncardiac pedal edema (5). Low testosterone and estrogen leading to reduced libido may result from hypothalamic‐pituitary suppression occurring during IT morphine administration (5,29).…”

Intrathecal Morphine Therapy-Related Granulomas: Faster to Grow than Thought

“…The most probable cause is a high concentration of the drug at one location. Many studies reported a relation between a high concentration of infused morphine and a granuloma formation (10,13). The best evidence for this hypothesis is that the granuloma forms at the tip of the catheter, where drug concentration is at its highest.…”

“…The acute and short‐term side‐effects of treatment with intrathecal morphine are well documented: nausea, respiratory depression, urinary retention, itching, vomiting, sedation, hypotension, seizures, hyperthermia, apnea, and coma (7). The development of an intrathecal granuloma was first reported in 1991 (8), and since then, it has become an increasingly reported long‐term side‐effect (8–18).…”