Tunneled Epidural Catheter Infections in Noncancer Pain: Increased Risk in Patients With Neuropathic Pain/Complex Regional Pain Syndrome

Abstract

The higher risk of tunneled epidural catheter infection observed in patients with neuropathic pain (particularly complex regional pain syndrome) warrants further study.

A Review of Epidural Catheter-Related Infections

“…With a tunneled epidural catheter (TEC), there is a potential decrease in the likelihood of spinal space infection, as the subcutaneous tunneled tract is at a greater distance from the spinal space. 2 Epidural catheters can be classified into 3 groups based on material: polyurethane, clear nylon, or radiopaque nylon. 9 In an in vitro study of catheter infections, 10 radiolabeled bacteria were exposed to 5 commonly used intravascular and urethral catheters.…”

“…Additionally, most studies describe antibiotic prophylaxis prior to epidural catheter placement for long-term infusions. 2,25 Surgically Implanted Catheters…”

“…1 in 10 to , 1 in 145 000. 2,3 This article reviews the relevant literature on epidural catheterrelated infections and strategies for their prevention, diagnosis, and management. An extensive search of the literature was performed using the National Library of Medicine database.…”

Pharmacokinetics of extended-release epidural morphine sulfate: Pooled analysis of six clinical studies

“…Indwelling epidural catheters may be associated with infection, hematoma formation, or abscess. 9,[11][12][13] Although epidural hematomas associated with indwelling catheters are relatively rare, they are often catastrophic and occur more frequently after epidural catheter removal in patients receiving postoperative anticoagulant therapy. These epidural hematomas generally require invasive emergency surgical intervention.…”

“…8 Risks associated with indwelling epidural catheters include infection, [9][10][11][12] epidural abscess, 11 and hematoma formation, especially in patients who receive postoperative anticoagulation therapy and are already at risk. 8,13 Moreover, a number of more recent, aggressive approaches to postsurgical anticoagulation frequently preclude the postoperative use of indwelling epidural catheters.…”