Background and Objectives There is at present no reliable method for long-term treatment of severe pain following complications of total hip arthroplasty. We explored the longterm use of continuous intrathecal opioid/bupivacaine analgesia in a case not amendable to corrective surgery.
Methods A 77-year-old woman, having a total hip arthroplasty, developed refractory nociceptive-neuropathic pain located at the ventral and dorsal aspects of the left hip. Radiographs showed a mandarine-sized intrapelvic mass of bone cement adhering to the roof of the acetabular cup. Further surgery had been declined by the surgeon and by the patient. An 18-gauge Portex intrathecal catheter was inserted, and an intrathecal infusion of 4.75 mg/mL bupivacaine and 0.015 mg/mL buprenorphine was started from a portable Pharmacia-Deltec (St. Paul, Minnesota) pump.
Results The mean daily doses during the treatment period (more than 6 years up to now) were 37 mg for bupivacaine and 0.114 mg for buprenorphine. The intrathecal treatment gave the patient 85-100% pain relief. The patient could transport herself in a wheelchair, was able to perform her own hygiene, receive visits, read, watch television, and also shop and visit restaurants. There has been no need to replace the intrathecal catheter.
Conclusion Intrathecal infusion of opioid/bupivacaine can provide satisfactory long-term analgesia in patients with refractory pain from the hip joint.
- total hip arthroplasty
- intrathecal opioid/bupivacaine.
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This work was supported by grants from families and friends of the patients with “refractory” pain treated with intrathecal morphine-bupivacaine in the City of Gothenburg and the Gothenburg region (No. 5753-24 955 02), by grant No. 8190 30 from the Research Council of the Faculty of Medicine of Göteburg University, and by a grant from Inga-Britt and Arne Lundberg's Research Foundation (No. 162/94). None of the grant givers had any economic interest in the elaboration and publication of this article.