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Related Experiment Videos

Leg edema from intrathecal opiate infusions.

J A Aldrete1, Couto da Silva JM

  • 1Department of Anesthesiology, University of South Florida School of Medicine, Tampa, Florida, USA. taldrete@arachnoiditis.com

European Journal of Pain (London, England)
|December 22, 2000
PubMed
Summary

Long-term intrathecal opiate infusions for chronic pain can cause severe leg edema. Pre-existing venous stasis and leg swelling indicate a higher risk, potentially contraindicating this treatment.

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Area of Science:

  • Pain Management
  • Neurosurgery
  • Pharmacology

Background:

  • Intrathecal infusions are increasingly used for long-term non-cancer pain.
  • This therapy carries risks of serious side-effects.
  • Opiate administration via intrathecal infusion requires careful patient selection.

Purpose of the Study:

  • To investigate the occurrence and predisposing factors of leg and feet edema in patients receiving long-term intrathecal opiate infusions.
  • To assess the impact of pre-existing venous conditions on the development of edema.
  • To evaluate the effect of dose reduction and discontinuation of intrathecal opiates on edema.

Main Methods:

  • Observational study of 23 patients with long-term intrathecal opiate infusions (>24 months).
  • Assessment of pre-existing conditions including cardiovascular disease, deep venous thrombosis, peripheral vascular disease, and lower extremity venous stasis.

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  • Monitoring for development of leg and feet edema and its severity.

    • Main Results:

    • Five out of 23 patients developed significant leg and feet edema.
    • All affected patients had pre-existing leg edema and venous stasis before pump implantation.
    • Edema severity was reduced by decreasing opiate dosage and resolved almost completely upon discontinuation.

    Conclusions:

    • Pre-existing pedal edema and venous stasis are relative contraindications for long-term intrathecal opiate infusion in chronic non-cancer pain.
    • Careful patient screening for venous insufficiency is crucial before initiating this therapy.
    • Management strategies include dose adjustment or cessation of intrathecal opiates to mitigate edema.