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Managing Complications of Intrathecal Medications Used for Pain

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Neuraxial Therapeutics

Abstract

Medication-related adverse effects of intrathecal analgesia require continued assessment throughout the course of treatment in patients with a targeted drug delivery system. Specific medication-related side effects are unique to the compound, dose, concentration, and rate of infusion. High doses of bupivacaine can result in paresthesias or motor weakness which limit dose escalation. Intrathecal clonidine can result in blood pressure lability which requires careful dose titration. Ziconotide, the N-type voltage gated calcium channel blocker, is most well-known for its psychiatric side effects, but is also implicated in elevations of creatine kinase, CNS side effects, and nausea. Intrathecal opioids pose risk of lower extremity edema, suppression of the hypothalamic pituitary and gonadal access, pruritus, nausea, respiratory depression, and granuloma formation. Rather than steering physicians away from targeted drug delivery therapy, the pump manager should remain aware of both the common and life-threatening side effects of various intrathecal agents in routine clinical practice, maintain an understanding of ways to address the adverse events should they occur and selected among heterogeneous agents for their own patient population.

Funding was provided by the Department of Evidence Based Pain Research, Cleveland Clinic, Cleveland, Ohio.

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Authors and Affiliations

  1. Departments of Anesthesiology and Utilization Management, Cedars-Sinai, Beverly Hills, CA, USA

    Robert B. Bolash

  2. Departments of Pain Management and Evidence Based Pain Research, Cleveland Clinic, Cleveland, OH, USA

    Nagy Mekhail

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  2. Nagy Mekhail
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  1. (CTF-312), UC San Diego-Anesthesia Res Lab 081 (CTF-312), La Jolla, CA, USA

    Tony Yaksh

  2. University Hospital, Case Western Reserve University, Cleveland, OH, USA

    Salim Hayek

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Bolash, R.B., Mekhail, N. (2023). Managing Complications of Intrathecal Medications Used for Pain. In: Yaksh, T., Hayek, S. (eds) Neuraxial Therapeutics. Springer, Cham. https://doi.org/10.1007/978-3-031-39558-1_33

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