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"Leg edema from intrathecal opiate infusions"
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J. Antonio Aldrete, M.D. and J. M. Couto da
Silva
Department of Anesthesiology, University of South Florida School of
Medicine, Tampa, Florida, USA
Arachnoiditis Foundation, Aldrete Pain Care Center, Dothan, Alabama,
USA
Anesthesia, University of Brasilia, Brasilia, Brazil |
Abstract
Despite the increasing popularity of
intrathecal infusions to treat patients with long-term
non-cancer-related pain, this therapy is not without serious
side-effects. Five out of 23 patients who had intrathecal infusions of
opiates for longer than 24 months developed leg and feet edema. As
predisposing factors, cardiovascular disease, deep venous thrombosis,
peripheral vascular disease, and venous stasis of the lower
extremities were considered. Every patient who developed pedal and leg
edema after the implantation of an infusion pump was also found to
have leg edema and venous stasis prior to the time when the pump was
inserted. This complication was severe enough to limit their physical
activity, and to produce lymphedema, ulcerations and hyperpigmentation
of the skin. Reduction of the edema occurred when the dose of the
opiate was decreased, and in two cases in which the infusion was
discontinued, there was almost complete resolution of the syndrome. It
appears that the pre-existence of pedal edema and of venous stasis is
a relative contraindication to the long-term intrathecal infusion of
opiates in patients with chronic non-cancer pain. |
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Originally appeared in:
European Journal of Pain,
Volume 4,
Issue 4, Pages 361-365 (December 2000) Received 21 December 1999;
accepted 11 July 2000. Available online 10 April 2002.
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