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Edema caused by continuous epidural hydromorphone infusion: a case report and review of the literature.
J Opioid Manag. 2008 Jul-Aug; 4(4):255-9.JO

Abstract

BACKGROUND

Intraspinal drug delivery (IDD) therapy has been increasingly employed in patients with intractable, nonmalignant pain. Before implantation of permanent intraspinal pump, an intraspinal opioid screening trial is conducted to demonstrate the efficacy. The patient-controlled continuous epidural opioid infusion trail, performed in an outpatient setting, is widely accepted by many interventional pain specialists.

OBJECTIVE

To report a case of severe edema observed during the continuous epidural hydromorphone infusion trial.

CASE REPORT

An otherwise healthy 68-year-old lady with a 5-year history of severe low back pain and bilateral leg pain because of failed back surgery syndrome was referred to our clinic for IDD therapy. A tunneled lumbar epidural catheter was placed at L2-L3 with catheter tip advanced to L1 under fluoroscopic guidance. Satisfactory catheter placement was confirmed by epidurogram. The catheter was then tunneled subcutaneously and connected to a Microject patient-controlled epidural analgesia (PCEA) pump (Codman, Raynham, MA). The pump was programmed to deliver hydromorphone (0.1 mg/ml) at basal rate of 0.3 ml/h. The bolus dose was 0.1 ml with a 60-minute lockout interval. The patient was instructed how to operate the infusion pump. During the following infusion trial, she reported satisfactory analgesia (> 70 percent pain reduction) and was able to wean off her other systemic opioids. However, she developed diffuse edema and gained over 16 pounds during the 5-day infusion trial. Her edema finally resolved 3-4 days after termination of the epidural infusion.

CONCLUSION

Edema may occur and persist during epidural hydromorphone infusion. This report represents the first case report, to the best of our knowledge, describing severe edema in a patient on continuous epidural hydromorphone administration during an outpatient epidural infusion trial.

Authors+Show Affiliations

Physician' Pain Specialists of Alabama, Mobile, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

18837206

Citation

Ruan, Xiulu, et al. "Edema Caused By Continuous Epidural Hydromorphone Infusion: a Case Report and Review of the Literature." Journal of Opioid Management, vol. 4, no. 4, 2008, pp. 255-9.
Ruan X, Tadia R, Liu H, et al. Edema caused by continuous epidural hydromorphone infusion: a case report and review of the literature. J Opioid Manag. 2008;4(4):255-9.
Ruan, X., Tadia, R., Liu, H., Couch, J. P., & Lee, J. K. (2008). Edema caused by continuous epidural hydromorphone infusion: a case report and review of the literature. Journal of Opioid Management, 4(4), 255-9.
Ruan X, et al. Edema Caused By Continuous Epidural Hydromorphone Infusion: a Case Report and Review of the Literature. J Opioid Manag. 2008 Jul-Aug;4(4):255-9. PubMed PMID: 18837206.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Edema caused by continuous epidural hydromorphone infusion: a case report and review of the literature. AU - Ruan,Xiulu, AU - Tadia,Riaz, AU - Liu,Hainan, AU - Couch,John Patrick, AU - Lee,John Keun-Sang, PY - 2008/10/8/pubmed PY - 2008/10/31/medline PY - 2008/10/8/entrez SP - 255 EP - 9 JF - Journal of opioid management JO - J Opioid Manag VL - 4 IS - 4 N2 - BACKGROUND: Intraspinal drug delivery (IDD) therapy has been increasingly employed in patients with intractable, nonmalignant pain. Before implantation of permanent intraspinal pump, an intraspinal opioid screening trial is conducted to demonstrate the efficacy. The patient-controlled continuous epidural opioid infusion trail, performed in an outpatient setting, is widely accepted by many interventional pain specialists. OBJECTIVE: To report a case of severe edema observed during the continuous epidural hydromorphone infusion trial. CASE REPORT: An otherwise healthy 68-year-old lady with a 5-year history of severe low back pain and bilateral leg pain because of failed back surgery syndrome was referred to our clinic for IDD therapy. A tunneled lumbar epidural catheter was placed at L2-L3 with catheter tip advanced to L1 under fluoroscopic guidance. Satisfactory catheter placement was confirmed by epidurogram. The catheter was then tunneled subcutaneously and connected to a Microject patient-controlled epidural analgesia (PCEA) pump (Codman, Raynham, MA). The pump was programmed to deliver hydromorphone (0.1 mg/ml) at basal rate of 0.3 ml/h. The bolus dose was 0.1 ml with a 60-minute lockout interval. The patient was instructed how to operate the infusion pump. During the following infusion trial, she reported satisfactory analgesia (> 70 percent pain reduction) and was able to wean off her other systemic opioids. However, she developed diffuse edema and gained over 16 pounds during the 5-day infusion trial. Her edema finally resolved 3-4 days after termination of the epidural infusion. CONCLUSION: Edema may occur and persist during epidural hydromorphone infusion. This report represents the first case report, to the best of our knowledge, describing severe edema in a patient on continuous epidural hydromorphone administration during an outpatient epidural infusion trial. SN - 1551-7489 UR - https://www.unboundmedicine.com/medline/citation/18837206/Edema_caused_by_continuous_epidural_hydromorphone_infusion:_a_case_report_and_review_of_the_literature_ L2 - http://www.diseaseinfosearch.org/result/2473 DB - PRIME DP - Unbound Medicine ER -