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Cervical radiculopathy treated by infusion of epidural analgesics in homebound patients
J A Aldrete1, C A Brown, K L Yarcho
1Center for Pain Management, Destin, FL 32541.
Study Objective:
To determine the efficacy and safety of administering low-dose analgesic infusions through cervical epidural catheters.
Design:
Retrospective review of medical records.
Setting:
Community hospital.
Patients:
14 ambulatory adult patients with chronic cervical radiculopathy due to posttraumatic or osteoarthritic degenerative disk disease persisting after steroid epidural blocks.
Interventions:
42 catheters were inserted into the cervical epidural space and infused with low-dose fentanyl-bupivacaine mixtures continuously for 2 to 17 days. To prevent side effects, the optimal dose was reached by upgrade adjustments. After catheter insertion, patients were observed for 6 to 21 days for dose adjustment, then discharged home and followed by homecare nurses. After removal of catheters, patients were followed for 8 to 10 days. If pain intensity returned to control levels, other treatment was initiated.
Measurements And Main Results:
After each catheter treatment, pain intensity was reduced in 79% of the cases. Upon completion of the therapy, 5 patients had 50% to 75% of their pain reduced. Eight patients experienced 75% or more reduction of their original pain. The most common complications were nausea (35.7%) and pruritus (27%). One case of cellulitis was treated with antibiotics. There were no instances of respiratory compromise.
Conclusions:
Patients with chronic persistent cervical radiculopathy pain were effectively treated with infusion of analgesics through epidural catheters for 2 to 17 days while they were at home.