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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims Intrathecal opioid therapy is indicated for various types of pain. Prior to the implantation of a programmable pump, a trial test is required. There is no consensus on the best method for conducting trial. We present a patient combining basal infusion of morphine with boluses using patient-controlled analgesia (PCA).
Methods 45-year-old severe traumatic injury in right lower limb 15 years ago, 30 surgeries including supracondylar amputation. Neuropathic pain in the stump and severe nonspecific lumbosacral pain. Multiple previous treatments: nerve blocks, rehabilitation, prolotherapy, high-dose methadone and adjuvants, infusions of dexmedetomidine and lidocaine. Multiple hospital admissions. Placement of an epidural catheter with fentanyl and bupivacaine infusion provided relief. It was decided to perform an intrathecal morphine trial.
Results Day1: Intrathecal catheter placed at T8. Initial bolus of 0.2mg of morphine sulfate (1mg/mL), and the PCA pump was programmed with a 10-hour lockout period. Then 0.1mg morphine boluses was programmed with a lockout period of 4 hours. The patient used 3 boluses. Day2: Continuous infusion was programmed with the total dose used on the previous day (0.5mg),boluses of 0.1mg with a 4-hour lockout period. The patient used 5 boluses, achieving VAS 2 only mild difficult to start urination was detected. Day3: Continuous infusion of 1mg over 24 hours was administered, imitating the definitive pump. Excellent response was maintained. The catheter was removed and implantation of an intrathecal pump was programmed.
PCA device and Intrathecal catheter
Conclusions PCA imitates the functioning of the definitive implantable pump and is a satisfactory method for conducting the intrathecal morphine trial.