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Resolution of Intrathecal Hydromorphone or Morphine‐induced Peripheral Edema by Opioid Rotation to Fentanyl: A Case Series
Author(s) -
Veizi Elias,
TorneroBold Melissa,
Hayek Salim M.
Publication year - 2016
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12443
Subject(s) - medicine , hydromorphone , morphine , fentanyl , anesthesia , edema , opioid , peripheral edema , saline , adverse effect , surgery , receptor
Intrathecal therapy [ IT ] has become an important modality for treatment of intractable cancer and noncancer pain although adverse events limit its effectiveness. Objective The purpose of this case series was to report and discuss the lower limb edema from IT hydromorphone and morphine therapy and its resolution or nonrecurrence upon rotating the IT solution to fentanyl. Methods Case series. Results Five patients, 4 women and 1 man, 55 to 67 years old implanted with IT delivery device systems [ IDDS ] were treated with continuous infusion of hydromorphone [4 subjects] at 95 ± 40 mcg/24 hours and morphine [1 subject] at 0.67 mg/24 hours. They developed peripheral edema of the lower extremities at an average of 4.2 months [mean, range 1 to 8 months] after implant. In 4 subjects, peripheral edema resolved by changing the IT agent to fentanyl. The mean time for complete resolution of edema was 50 ± 20 days while patients were treated with continuous infusion of fentanyl. It should be noted that all patients were receiving bupivacaine in addition to the IT opioid. In one subject, infusion of IT saline resulted in faster resolution of peripheral edema. Conclusion Peripheral lower extremity edema may occur in patients treated with IT infusion of hydromorphone or morphine, even at low doses. This report presents, to the best of our knowledge, the first case series describing the benefit of IT opioid rotation to fentanyl in alleviating challenging lower extremity edema from IT hydromorphone and morphine.