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Intrathecal granuloma formation in a patient receiving long-term spinal infusion of tramadol
José De Andrés1, José Tatay Vivò, Stefano Palmisani
1Department of Anesthesia, Critical Care and Multidisciplinary Pain Management, General University Hospital, Valencia, Spain. deandres_jos@gva.es
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.
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