Open AccessRecurrent Cellulitis Associated with Long‐Term Intrathecal Opioid Infusion Therapy: A Case Report and Review of the Literature
Author(s) -
Ruan Xiulu,
Liu HaiNan,
Couch J. Patrick,
Wang Frank,
Chiravuri Srinivas
Publication year - 2010
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2010.00854.x
Subject(s) - medicine , edema , hydromorphone , anesthesia , cellulitis , clonidine , opioid , surgery , morphine , receptor
Background. Lower‐limb edema is recognized as an untoward side effect of intrathecal opioid therapy. Cellulitis, an acute, spreading pyogenic inflammation of the dermis and subcutaneous tissue, predisposed by persistent leg edema, can become problematic in patients on intraspinal opioid infusion therapy. Objective. To present a case of recurrent cellulitis in an elderly lady with persistent leg edema associated with intrathecal morphine/hydromorphone infusion therapy. Case Report. Sixty‐one‐year‐old woman with intractable chronic low back pain and bilateral leg pain treated with an intrathecal infusion of morphine up to 5 mg/day over 3 months with satisfactory pain control developed progressive lower extremity edema, complicated by recurrent cellulitis, requiring repeated hospitalization and intravenous antibiotic treatment. Switching to intrathecal hydromorphone helped minimally. Intrathecal baclofen and clonidine infusion resulted in complete resolution of leg edema and pain relief over the following 12 months. Conclusion. Intrathecal Baclofen and Clonidine may be used as alternatives to provide spinally mediated antinociception when intraspinal opioid fails due to pharmacological side effects such as persistent edema.