Infections from extended epidural catheterization in ambulatory patients.
OBJECTIVE
Patients with severe and noncancer pain were treated with prolonged epidural infusions of analgesics in their homes, and the incidence of infection was determined.


METHODS
In 504 adult patients, 3,164 polyamide lumbar epidural catheters were infused with analgesics of low-dose bupivacaine and fentanyl intermittently from 2 to 80 days at their home. When patients developed fever, headache, back pain, and leukocytosis, the presence of infection was confirmed by either computed tomographic scan, epidurogram, or sonogram.


RESULTS
Nine infections (0.27%) occurred. Of these, two were epidural abscesses, two were fascitis, and five were cellulitis. Staphylococcus epidermidis was cultured in every case. All of them were treated with 1.5 g intravenous cefuroxime sodium every 8 hours. None of the patients required surgical intervention. In a subgroup of patients treated with the first 1,462 infused catheters, seven infections developed (0.4%), whereas in the subsequent 1,702 cases that received prophylactic penicillin or erythromycin, in 6-day cycles, there were only two infections (0.11%).


CONCLUSIONS
Temporary epidural infusions of analgesics up to 80 days are feasible in ambulatory patients with a low rate of infections. Preliminary observations appear to indicate that prophylactic antibiotics given intermittently further reduce the feasibility of infections. However, these observations may not apply to longer-lasting epidural infusions.
Health Destinations, The Institute for the Study of Treatment of Arachnoiditis, Santa Rosa Beach, Florida 32459, USA.
J A
JA
Aldrete
S K
SK
Williams
D000328:Adult; D000553:Ambulatory Care; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002908:Chronic Disease; D005334:Fever / Q000209:etiology; D006801:Humans; D010146:Pain / Q000188:drug therapy; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications / Q000209:etiology*; D013212:Staphylococcus epidermidis