title: Six years of continuous intrathecal infusion of opioid and bupivacaine in the treatment of refractory pain due to intrapelvic extrusion of bone cement after total hip arthroplasty.
abstract: OBJECTIVE
  There is at present no reliable method for long-term treatment of severe pain following complications of total hip arthroplasty. We explored the long-term use of continuous intrathecal opioid/bupivacaine analgesia in a case not amendable to corrective surgery.
  
  
  METHODS
  A 77-year-old woman, having a total hip arthroplasty, developed refractory nociceptive-neuropathic pain located at the ventral and dorsal aspects of the left hip. Radiographs showed a mandarine-sized intrapelvic mass of bone cement adhering to the roof of the acetabular cup. Further surgery had been declined by the surgeon and by the patient. An 18-gauge Portex intrathecal catheter was inserted, and an intrathecal infusion of 4.75 mg/mL bupivacaine and 0.015 mg/mL buprenorphine was started from a portable Pharmacia-Deltec (St. Paul, Minnesota) pump.
  
  
  RESULTS
  The mean daily doses during the treatment period (more than 6 years up to now) were 37 mg for bupivacaine and 0.114 mg for buprenorphine. The intrathecal treatment gave the patient 85-100% pain relief. The patient could transport herself in a wheelchair, was able to perform her own hygiene, receive visits, read, watch television, and also shop and visit restaurants. There has been no need to replace the intrathecal catheter.
  
  
  CONCLUSIONS
  Intrathecal infusion of opioid/bupivacaine can provide satisfactory long-term analgesia in patients with refractory pain from the hip joint.
authors.affiliation: Department of Anaesthesia, Sahlgrenska University Hospital, Göteborg University, Gothenburg, Sweden.
authors.forename: P O
authors.initials: PO
authors.lastname: Dahm
authors.forename: P V
authors.initials: PV
authors.lastname: Nitescu
authors.forename: L K
authors.initials: LK
authors.lastname: Appelgren
authors.forename: I D
authors.initials: ID
authors.lastname: Curelaru
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D010148:Intractable Pain / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D001843:Bone Cements; D002045:Bupivacaine