Intrathecal catheter granuloma associated with continuous sufentanil infusion.
Intrathecal sufentanil is a minimally utilized opioid for patients with intractable pain refractory to traditional intrathecal medications. We present an 86-year-old female with a history of multiple spine surgeries who eventually progressed to having chronic, intractable, and diffuse low back pain. After failing medical management, she underwent a successful intrathecal trial of opioid therapy and was subsequently treated with an implantable drug delivery system (IDDS) or intrathecal pump. We describe the first reported case of formation of a catheter tip granuloma associated with intrathecal infusion of sufentanil. Due to increasing opioid requirements and gradually escalating pain, a computed tomography myelogram was performed to explore neuraxial etiologies of her symptoms. This investigation revealed the presence of a catheter tip-associated inflammatory mass (granuloma). All patients receiving intrathecal medications, including sufentanil, must be considered for the possibility of catheter-associated granuloma, particularly with symptoms of altered neurological function and/or increasing medication requirements associated with worsening pain.
Gupta
Anita
A
Division of Penn Pain Medicine, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania 19146, USA. anita.gupta@uphs.upenn.edu
Martindale
Ty
T
Christo
Paul J
PJ
D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006099:Granuloma / Q000209:etiology*; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects / Q000379:methods; D017116:Low Back Pain / Q000188:drug therapy / Q000601:surgery; D017409:Sufentanil / Q000009:adverse effects / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D000701:Analgesics, Opioid; D017409:Sufentanil