Intrathecal Catheter as a Source of Infection Years After Implantation of an Intrathecal Drug Delivery System: A Case Report.

We describe a patient with an intrathecal drug delivery system (IDDS) for management of chronic back pain who developed worsening pain symptoms associated with an infected catheter tip, identified years after initial implantation. A 72-year-old woman had an IDDS initially implanted for management of chronic back pain. Years later, after suffering a vertebral compression fracture, workup revealed magnetic resonance imaging (MRI) findings suggestive of infection despite unremarkable laboratory findings. Her pain worsened, and after explantation of the IDDS, methicillin-resistant Staphylococcus aureus colonized the catheter tip. Worsening pain symptoms in a patient with intrathecal morphine pump must be met with a broad differential diagnosis.

Paravertebral Catheter Use for Postoperative Pain Control in Patients After Lung Transplant Surgery: A Prospective Observational Study.

OBJECTIVE: Effective postoperative pain management has been shown to be a positive predictive factor for postoperative recovery following a thoracotomy. The primary objective of this study was to examine the efficacy and safety of continuous paravertebral blockade in managing acute postsurgical pain following unilateral and bilateral single-lung transplantation. DESIGN: The authors conducted a prospective observational trial of patients. SETTING: The study was conducted in an academic university hospital. PARTICIPANTS: Patients (≥18 years of age) who underwent either unilateral or bilateral single-lung transplantation and received a postoperative paravertebral catheter. INTERVENTIONS: Paravertebral catheters were placed via an ultrasound-guided technique on either postoperative day 1 or 2. After placement, a continuous infusion of 0.2% ropivacaine was run at 0.2 to 0.25 mL/kg/h with maximum dose of 7 mL/h per side in bilateral lung transplant patients, and 14 mL/h in unilateral lung transplant patients. MEASUREMENTS AND MAIN RESULTS: Patients were followed up to 120 hours after placement of catheters, and pain scores, opioid use, and adverse events were recorded. There were 35 patients who completed the study from October 2013 to December 2014 (21 bilateral transplants and 14 unilateral transplants). The mean time to paravertebral catheter placement was 1.14 days in the overall group, with median time to extubation occurring 543 minutes after placement (range, 23-2,985 minutes). Catheters remained in place for a mean of 7.18 days. The mean maximal pain scores for both groups was 5.94 (day 1), 6.26 (day 2), 6.20 (day 3), 5.12 (day 4), and 5.60 (day 5). There were no adverse events related to the paravertebral catheters in either group. CONCLUSIONS: Paravertebral catheters provide a feasible option for postoperative pain control following unilateral or bilateral single-lung transplant in adult patients. Future research should focus on randomized trials of thoracic epidurals compared to paravertebral catheters.