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Irish Journal of Medical Science

, Volume 183, Issue 2, pp 293–296 | Cite as

An assessment of intrathecal catheters in the perioperative period: an analysis of 84 cases

  • V. D. WardEmail author
  • C. R. Mc Crory
Original Article

Abstract

Background

Intrathecal opioid administration yields high quality analgesia with an associated low incidence of side effects and complication. The benefits of spinal “opioid only technique” include absence of neuronal blockade, infusion pump malfunction and sympathetic blockade. This technique declined after serious side effects were reported in the 1990s.

Aims

To report on the safety and efficacy of the intrathecal catheter repeat bolus morphine technique for postoperative analgesia in patients having thoracotomy.

Methods

A 22 gauge intrathecal catheter was inserted through the lumbar 3–4 interspace prior to induction of anaesthesia for postoperative analgesia. Repeat bolus preservative-free morphine was administered for 48 h, target VAS was <4.

Results

The mean morphine administered via ITC in 48 h was 2.56 mg (±SD 0.88 mg). Only one patient required rescue morphine. There were no serious complications or sequelae at 6-month follow-up.

Conclusions

Intrathecal morphine for post-op analgesia is efficacious and safe in a post-thoracotomy population.

Keywords

Indwelling catheter Morphine Postoperative pain Spinal injections Thoracotomy 

References

  1. 1.
    Arkoosh VA, Palmer CM, Yun EM, Sharma SK et al (2008) A randomized, double-masked, multicenter comparison of the safety of continuous intrathecal labor analgesia using a 28-gauge catheter versus continuous epidural labor analgesia. Anaesthesiology 108(2):286–298CrossRefGoogle Scholar
  2. 2.
    Mikko Pitkänen (1998) Continuous spinal anaesthesia and analgesia. Tech Region Anaesth Pain Manage 2(2):96–102Google Scholar
  3. 3.
    Tuohy EB (1944) Continuous spinal anaesthesia, its usefulness and technique involved. Anaesthesiology 5:142–148CrossRefGoogle Scholar
  4. 4.
    Rigler ML, Drasner K, Krejcie TC et al (1991) Cauda equina syndrome after continuous spinal anaesthesia. Anesth Analg 72:275–281PubMedCrossRefGoogle Scholar
  5. 5.
    Benson JS (1992) US food and drug administration safety alert: cauda equina syndrome associated with use of small-bore catheters in continuous spinal anaesthesia. AANA J 60:223PubMedGoogle Scholar
  6. 6.
    Gwirtz KH, Young JV, Byers RS et al (1999) The safety and efficacy of intrathecal opioid analgesia for acute postoperative pain: 7 years experience with 5,969 surgical patients at Indiana university hospital. Anesth Analg 88:599–604PubMedGoogle Scholar
  7. 7.
    Muralidhar V, Kaul HL, Mallick P (1999) Over-the-needle versus micro catheter-through-needle technique for continuous spinal anaesthesia: a preliminary study. Reg Anesth Pain Med 24:417–421PubMedGoogle Scholar
  8. 8.
    International Headache Society (1988) Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache classification committee of the international headache society. Cephalalgia 8(Suppl 7):1–96Google Scholar
  9. 9.
    International Headache Society (2004) The international classification of headache disorders: 2nd edition. Cephalalgia 24(Suppl 1):9–160Google Scholar
  10. 10.
    Horlocker TT, McGregor DG, Matsushige DK, Perioperative Outcomes Group et al (1997) Neurologic complications of 603 consecutive continuous spinal anaesthetics using macro catheter and micro catheter techniques. Anesth Analg 84:1063–1070PubMedGoogle Scholar
  11. 11.
    de Andres J, Bellver J, Bolinches R (1994) Comparison of continuous spinal anaesthesia using a 32-gauge catheter with anaesthesia using a single-dose 24-gauge atraumatic needle in young patients. Br J Anaesth 73:747–750PubMedCrossRefGoogle Scholar
  12. 12.
    Hurley RJ, Lambert DH (1990) Continuous spinal anaesthesia with a micro catheter technique: preliminary experience. Anesth Analg 70:97–102PubMedCrossRefGoogle Scholar
  13. 13.
    Grady RE, Horlocker TT, Brown RD, Maxson PM, Schroeder DR, Mayo Perioperative Outcomes Group (1999) Neurologic complications after placement of cerebrospinal fluid drainage catheters and needles in anesthetized patients: implications for regional anaesthesia. Anesth Analg 88:388–392PubMedGoogle Scholar
  14. 14.
    Turnbull DK, Shepherd DB (2003) Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 91:718–729PubMedCrossRefGoogle Scholar
  15. 15.
    Brown DL (1999) Spinal, epidural, and caudal anaesthesia. In: Miller RD (ed) Anaesthesia, 5th edn. Churchill Livingstone, Edinburgh, pp 1491–1519Google Scholar
  16. 16.
    Bevacqua BK (2003) Continuous spinal anaesthesia: what’s new and what’s not. Best Pract Res Clin Anaesthesiol 17:393–406PubMedCrossRefGoogle Scholar
  17. 17.
    Moen V, Dahlgren N, Irestedt L (2004) Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anaesthesiology 101:950–959CrossRefGoogle Scholar
  18. 18.
    Giebler RM, Scherer RU, Peters J (1997) Incidence of neurologic complications related to thoracic epidural catheterization. Anaesthesiology 86:55–63CrossRefGoogle Scholar
  19. 19.
    de Jong RH (1994) Last round for a “heavyweight”? Anesth Analg 78:3–4PubMedGoogle Scholar
  20. 20.
    McCrory C, Diviney D, Moriarty J, Luke D, Fitzgerald D (2002) Comparison between repeat bolus intrathecal morphine and an epidurally delivered bupivacaine and fentanyl combination in the management of post-thoracotomy pain with or without cyclooxygenase inhibition. J Cardiothorac Vasc Anesth 16:607–611PubMedCrossRefGoogle Scholar
  21. 21.
    Bevacqua BK, Slucky AV, Cleary WF (1994) Is postoperative intrathecal catheter use associated with central nervous system infection? Anaesthesiology 80:1234–1240CrossRefGoogle Scholar
  22. 22.
    McLeod G, Davies H, Munnoch N, Bannister J, MacRae W (2001) Postoperative pain relief using thoracic epidural analgesia: outstanding success and disappointing failures. Anaesthesia 56:75–81PubMedCrossRefGoogle Scholar
  23. 23.
    Biboulet P, Capdevila X, Aubas P et al (1998) Causes and prediction of maldistribution during continuous spinal anaesthesia with isobaric or hyperbaric bupivacaine. Anaesthesiology 88:1487–1494CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2013

Authors and Affiliations

  1. 1.Department of Pain MedicineSt. James HospitalDublin 8Ireland

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