Intrathecal inflammatory masses: Is the yearly opioid dose increase an early indicator?

Duarte, R.V. and Raphael, J.H. and Southall, J.L. and Baker, C. and Hanu-Cernat, D. (2010) Intrathecal inflammatory masses: Is the yearly opioid dose increase an early indicator? Neuromodulation, 13 (2). pp. 109-112. ISSN 10947159 (ISSN)

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Abstract

Objectives: The objective of this study is to investigate the association between intrathecal drug, flow rate, drug concentration, and drug dose with the formation of intrathecal inflammatory masses. Methods: A retrospective longitudinal study of 56 consecutive patients receiving long-term intrathecal analgesic administration was undertaken through screening of medical records. Data regarding drug flow rate, dose per day, and concentration of drugs administered were recorded for morphine, diamorphine, bupivicaine, clonidine and baclofen and averages computed. Results: The average follow-up time post-implant was 91 ± 55 months (range: 9-209). Four of the 56 patients were diagnosed with intrathecal granuloma indicating a rate of 7%, the equivalent to 0.009 events per patient year. Twenty-one of the patients had received morphine either alone or combined; 22 had received diamorphine either alone or mixed; and 13 crossed over from morphine to diamorphine or the inverse. None of the patients with granuloma crossed over before diagnosis. A significant correlation was found between opioid dose (r = 0.275, p < 0.05), yearly increase of the opioid dose (r = 0.433, p < 0.05), and granuloma formation. Clonidine appeared to have a protective effect for the non-granuloma patients. No association was found with flow rate (r = 0.056) or opioid concentration (r = 0.214). Conclusion: This is the first detailed study showing an association of diamorphine with granulomas. This study supports the previous finding of intrathecal opioid dose being a risk factor for intrathecal granulomas and clonidine being protective. In addition we have found that the yearly increase in opioid dose is a risk factor for granulomas and could serve as an indicator for closer surveillance. © 2009 International Neuromodulation Society.

Item Type: Article
Uncontrolled Keywords: Clonidine, Diamorphine, Granuloma, Long-term intrathecal analgesic administration, Opioid dose, analgesic agent, baclofen, bupivacaine, clonidine, diamorphine, morphine, opiate, adult, aged, article, autoinflammatory disease, drug blood level, drug dose increase, female, flow rate, granuloma, human, intrathecal drug administration, long term care, longitudinal study, major clinical study, male, medical record, retrospective study, risk factor
Subjects: A100 Pre-clinical Medicine
A300 Clinical Medicine
Divisions: UoA Collections > UoA 03: Allied Health Professions, Dentistry, Nursing & Pharmacy
Depositing User: Yasser Nawaz
Date Deposited: 26 Feb 2017 05:19
Last Modified: 26 Feb 2017 05:19
URI: http://www.open-access.bcu.ac.uk/id/eprint/2850

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