Encapsulation of an intrathecal catheter.
A 47-year-old patient with cancer pain underwent implantation of an intrathecal drug delivery device. When the patient suffered from an infection with fever, pain on injection into the catheter and an elevated number of granulocytes in the cerebrospinal fluid 7 weeks later, radiologic examination showed an encapsulation of the catheter tip. Concentrations of morphine and morphine-6-glucuronide in the cerebrospinal fluid suggested transport of morphine into the systemic circulation via the vascularisation of the encapsulating membrane. After antibiotic therapy and removal of the catheter, morphine was administered intravenously with a one to one conversion ratio.
Department of Anaesthesiology, University of Cologne, 50924 Cologne, Germany. jrgaertner@aol.com
Jan
J
Gaertner
Rainer
R
Sabatowski
Frank
F
Elsner
Lukas
L
Radbruch
D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000097:blood / Q000134:cerebrospinal fluid / Q000138:chemical synthesis; D001943:Breast Neoplasms / Q000097:blood / Q000150:complications / Q000188:drug therapy; D002404:Catheterization / Q000009:adverse effects / Q000379:methods; D003287:Contrast Media / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D004824:Epidural Space; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal / Q000379:methods*; D008279:Magnetic Resonance Imaging; D009020:Morphine / Q000008:administration & dosage* / Q000097:blood / Q000134:cerebrospinal fluid / Q000138:chemical synthesis; D010146:Pain / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors
D000701:Analgesics, Opioid; D003287:Contrast Media; D009020:Morphine