title: Near Death Experience from Placement of an Intrathecal Catheter.
abstract: The management of pain due to cancer is challenging and often requires invasive therapy in addition to medication management. Intrathecal drug delivery is a form of advanced therapy that delivers medication locally in the intrathecal space while reducing systemic side effects associated with high doses of opioids. Although risks associated with intrathecal drug delivery are low, some common complications include dislodgement, kinking, or fracture of the catheter, bleeding, neurological injury, infection, and cerebrospinal leaks. We present a case of a 38-year-old woman with a medical history significant for stage IV breast cancer, L2 metastatic lesion, opioid tolerance, and chronic neck and low back pain who was admitted to the hospital for intractable pain. She had failed multiple interventional procedures in the past including lumbar medial nerve radiofrequency ablation, epidural steroid injection, and trigger point injections as well as a kyphoplasty at the L2 level. Failing both oral and parenteral opioid treatments, the decision was made to place an intrathecal pump in the patient. After placement of the intrathecal catheter and prior to any bolus of medication being given, the patient became bradycardic with a heart rate in the 20s and experienced a 10 second pause. The patient had intermittent bradycardia over the following days and symptoms resolved only after removal of the intrathecal catheter itself. To our knowledge, this is the first reported case with a complication of recurrent bradycardic and asystolic episodes prior to the administration of intrathecal opioid but shortly after placement of the intrathecal catheter itself.
  
  
  
  Intrathecal drug delivery, complications, cancer pain, intrathecal analgesia, bradycardia, opioids.
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Devang
authors.initials: D
authors.lastname: Padalia
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Jassal
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Sagar
authors.initials: S
authors.lastname: Patel
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D001919:Bradycardia / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy; D002404:Catheterization / Q000009:adverse effects; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal / Q000009:adverse effects* / Q000379:methods; D017116:Low Back Pain / Q000188:drug therapy; D010148:Intractable Pain / Q000188:drug therapy / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid