title: Serious complications associated with external intrathecal catheters used in cancer pain patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Potential risks of intrathecal catheters in cancer patients include infection, bleeding, and neurologic injury.
  
  
  METHODS
  A systematic review and a pooled analysis of observational studies were performed. Articles reporting on adverse events (infections, bleeding, granuloma, and death) associated with intrathecal catheters and external pumps in cancer patients were identified. Electronic searches of PubMed, MEDLINE, and EMBASE were conducted. Observations from different studies were pooled using a generalized mixed-effect model. Model estimates and their standard errors (SEs) were used for calculating 95% confidence intervals (CIs) on the overall proportion.
  
  
  RESULTS
  The analysis identified 10 articles, including a total of 821 patients. Twenty catheter-related infections were identified. Of these, 10 were superficial and 10 were deep infections, with rates of 2.3% (95% CI, 0.8-6.1) and 1.4% (95% CI, 0.5-3.8), respectively. Furthermore, the authors calculated that every 71st patient had a deep infection after an average catheter duration of 54 days. The risk of bleeding was found to be 0.9% (95% CI, 0-2.0), and for neurologic injury 0.4% (95% CI, 0-1.0). The infection rates are comparable to other intrathecal catheter techniques.
  
  
  CONCLUSIONS
  Serious complications are rare in both hospitalized and homebound patients with intrathecal catheters. This analysis supports the reasoning that the potential benefit of intrathecal catheters in the treatment of severe cancer pain is likely to outweigh the potential for serious complications associated with this technique. Therefore, an external intrathecal catheter can be considered an effective and low-cost solution for the control of pain in such patients.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Aprili
authors.forename: Oliver
authors.initials: O
authors.lastname: Bandschapp
authors.forename: Christoph
authors.initials: C
authors.lastname: Rochlitz
authors.forename: Albert
authors.initials: A
authors.lastname: Urwyler
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Ruppen
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000401:mortality; D002404:Catheterization / Q000009:adverse effects* / Q000401:mortality*; D003627:Data Interpretation, Statistical; D006099:Granuloma / Q000473:pathology; D006470:Hemorrhage / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007260:Infusion Pumps / Q000009:adverse effects; D007278:Injections, Spinal / Q000009:adverse effects*; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000209:etiology