Spinal cord lesion after long-term intrathecal clonidine and bupivacaine treatment for the management of intractable pain.
Long-term intrathecal drug administration using implanted pumps is increasingly used in the treatment of chronic refractory pain [Anderson and Burchiel 1999, Neurosurgery 44 (1999) 289; Krames 2002, Best Pract Res Clin Anaesthesiol 16 (2002) 619; Wallace 2002, Neurology 59 (2002) S18]. Extensive clinical experience over the last 15 years suggests that in selected cases the technique is safe, although infections, system malfunction and drug-related complications have been reported. In most cases, drug-related spinal cord injuries have resulted from the compression of a spinal inflammatory mass or abcess rather than from a direct neurotoxic effect. We report on a case of toxic spinal cord lesion occurring after more than 3 years of uneventful continuous infusion of a mixture of bupivacaine and clonidine.
Perren
Fabienne
F
CHUV, Neurology Department, 1011 Lausanne, Switzerland. fabienneperren@yahoo.com
Buchser
Eric
E
Chédel
Dominique
D
Hirt
Lorenz
L
Maeder
Philippe
P
Vingerhoets
François
F
D015360:Analgesia, Epidural / Q000379:methods; D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use; D002045:Bupivacaine / Q000009:adverse effects* / Q000627:therapeutic use; D003000:Clonidine / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015918:Infusion Pumps, Implantable; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D010148:Intractable Pain / Q000188:drug therapy; D013119:Spinal Cord Injuries / Q000139:chemically induced* / Q000473:pathology; D016896:Treatment Outcome
D000700:Analgesics; D003000:Clonidine; D002045:Bupivacaine