Spinal cord lesion after long-term intrathecal clonidine and bupivacaine treatment for the management of intractable pain

Abstract

Long-term intrathecal drug administration using implanted pumps is increasingly used in the treatment of chronic refractory pain [Anderson and Burchiel 1999, Neurosurgery 44 (1999) 289; Krames 2002, Best Pract Res Clin Anaesthesiol 16 (2002) 619; Wallace 2002, Neurology 59 (2002) S18]. Extensive clinical experience over the last 15 years suggests that in selected cases the technique is safe, although infections, system malfunction and drug-related complications have been reported. In most cases, drug-related spinal cord injuries have resulted from the compression of a spinal inflammatory mass or abcess rather than from a direct neurotoxic effect. We report on a case of toxic spinal cord lesion occurring after more than 3 years of uneventful continuous infusion of a mixture of bupivacaine and clonidine.

Neurohistopathological findings after continuous intrathecal administration of opioids and bupivacaine for pain treatment in cancer patients

“…In these cases, the dosage of bupivacaine was 24−26.6 mg/day. The dose of bupiva- caine given to the current patients was about 5−60 mg/day, which was almost the same as daily dosage that reported by Mercadante et al 7) Compared to the daily dosage administered by Perren et al 8) (24−26.6 mg/day), while our daily dosage (5−60 mg/day) was higher, the period of administration was shorter, at less than one year for all our cases.…”

“…Mercadante et al 7) reported that there were no neurological sequelae and that neurotoxicity did not readily develop if the dose of bupivacaine did not exceed 30−60 mg/day. Additionally, Perren et al 8) have reported that inflammatory mass forming in the spinal cord has been recognized in cases in which intrathecal administration of a mixture of bupivacaine and clonidine has been continued for three years or more. In these cases, the dosage of bupivacaine was 24−26.6 mg/day.…”

Extensive scarring induced by chronic intrathecal tubing augmented cord tissue damage and worsened functional recovery after rat spinal cord injury

“…With the passage of time, the connective tissue scarring occurs, develops, and increases in thickness, and finally compresses the cord tissue and spinal root, resulting in serious damage to the cord tissue. This is a likely cause of the impairment to functional recovery and of neurological deficits (Perren et al, 2004;Deer et al, 2007;Zacest et al, 2009;Medel et al, 2010).…”

Spinal and epidural analgesia in the management of chronic pain

“…Les complications mécaniques à longs termes sont tout à fait exceptionnelles [5], de même que les accidents neurologiques, et sont imputables à la méthode [19].…”