Open AccessIntrathecal Granuloma Formation in a Patient Receiving Long‐Term Spinal Infusion of Tramadol
Author(s) -
De Andrés José,
Tatay Vivò José,
Palmisani Stefano,
Villanueva Pérez Vicente L.,
Mínguez Ana
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.1526-4637.2010.00885.x
Subject(s) - hydromorphone , medicine , tramadol , morphine , anesthesia , intrathecal , opioid , granuloma , spinal cord , complication , surgery , analgesic , pathology , receptor , psychiatry
Objective. Intrathecal granuloma associated to the tip of subarachnoid catheters implanted in patients receiving long‐term spinal infusion is a rare but potentially catastrophic complication. Its development seems to be related to the intrathecal administration of opioid drugs, although not all opioids induce granuloma formation with the same frequency. Design. Morphine or hydromorphone‐related granulomas have been reported extensively in the literature, but there are no data about any of the other opioids currently used in an off‐label fashion when first‐line drugs are contraindicated. Setting and Patients. In this case, we report the first documented case of intrathecal granuloma formation in a patient receiving long‐term spinal infusion of tramadol, and we put forward a hypothesis for its development. Results and Conclusions. Chronic intrathecal administration of high‐dose tramadol could cause an inflammatory mass as it can be caused by similar, off‐label infusions of morphine or hydromorphone. Additionally, tramadol stimulates the activity of natural killers and the proliferation of lymphocytes.