Neurological impairment during long-term intrathecal infusion of bupivacaine in cancer patients: a sign of spinal cord compression.
Adequate pain relief in patients with far advanced cancer sometimes requires intrathecal (IT) administration of a combination of opioids and local anesthetics. Tumor progression as well as the IT administration of local anesthetics can lead to neurologic dysfunction during treatment. Five patients showed symptoms of compression of the cauda equina or spinal cord shortly after the start of combined IT administration of morphine and bupivacaine in a dosage usually not associated with neurologic symptoms. Unexpectedly, neurologic evaluation suggested compression of the cauda equina and spinal cord, which was confirmed radiographically. Manifestation of new neurologic symptoms during low dose bupivacaine infusion intrathecally might therefore be an early indicator of space-occupying processes within the spinal canal in cancer patients.
van Dongen
R T
RT
Department of Pain Treatment, University Hospital Nijmegen, The Netherlands. r.vandongen@anes.azn.nl
van Ee
R
R
Crul
B J
BJ
D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications*; D009422:Nervous System Diseases / Q000139:chemically induced / Q000150:complications* / Q000000981:diagnostic imaging; D013117:Spinal Cord Compression / Q000139:chemically induced / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; D009020:Morphine; D002045:Bupivacaine