Querschnittsmyelopathie als Komplikation einer intrathekalen Langzeitapplikation von Morphium bei chronischen Rückenschmerzen

Zusammenfassung:

Schwerwiegende neurologische Komplikationen nach intrathekaler Dauerapplikation von Opiaten sind selten beschrieben. Wir berichten von einem kernspintomographisch gesicherten Fall mit Entwicklung einer Paraparese der Beine mit sensiblem Querschnitt und Harnverhalt drei Monate nach Reimplantation eines Spinalkatheters zur Schmerztherapie. Eine Regredienz der Symptomatik trat erst nach Explantation des Pumpen-Spinalkatheter-Systems ein. Mögliche Ursachen und Konsequenzen werden diskutiert.

Serious neurological complications following long-term intrathecal application of opiates have seldom been published. This report describes complications which developed three months after reimplantation of a spinal catheter for pain therapy. The symptoms which occurred were paraparesis of the legs with sensory loss and urinary retention. A regression of these symptoms occurred only after explantation of the spinal catheter-pump-system. Possible reasons and consequences are discussed.

Schmerztherapie - Intrathekal - Langzeitapplikation - Morphium - Komplikation

Pain-Therapy - Intrathecal - Long-term Application - Morphine - Complication

Literatur

• 1 Abouleish E, Barmada M A. et al. . Acute and Chronic Effects of Intrathecal Morphine in Monkeys.  Br. J. Anaesth.. 1981;  53 1027-1032
• 2 Aldrete J A, Vascallo R, Tomlin D. Paraplegia in a Patient with an Intrathecal Catheter and a Spinal Cord Stimulator.  Anesthesiology. 1994;  81 1542-1545
• 3 Arnér S, Arnér B. Differential Effects of Epidural Morphine in the Treatment of Cancer-related Pain.  Acta Anaesthesiol. Scand.. 1985;  29 32-36
• 4 Blount J P, Remley K B. et al. . Intrathecal Granuloma Complicating Spinal Infusion of Morphine.  J. Neurosurg.. 1996;  84 272-276
• 5 Bromage P R. The Price of Intraspinal Narcotic Analgesia: Basic Constraints.  Anesth. Analg.. 1981;  60 461-463
• 6 Brook I. Role of Anaerobic Bacteria in Aortofemoral Graft Infection.  Surgery. 1988;  104 843-848
• 7 Coombs D W, Fratkin J D. et al. . Neuropathologic Lesions and CSF Morphine Concentrations during Chronic Continuous Intraspinal Morphine Infusion. A Clinical and Post-Mortem-Study.  Paira. 1985;  22 337-351
• 8 Coombs D W, Colburn R W. et al. . Toxicity of Chronic Spinal Analgesia in a Canine Model: Neuropathologic Observations with Dezocine Lactate.  Reg. Anesth.. 1990;  15 94-102
• 9 Donner B, Tryba M. et al. . Gefahren und Komplikationen bei rückenmarksnahen Katheterverfahren.  Der Schmerz.. 1995;  9 219-234
• 10 Eriksen K, Bigler D. et al. . Long-Term Treatment with Intrathecal Morphine in Severe Painful Cancer.  Ugeskr Laeger. 1989;  151 2365-2366
• 11 Everett E D, Eickhoff T C. et al. . Cerebrospinal Fluid Shunt Infections with Anaerobic Diphteroids (Propionibacterium Species).  J. Neurosurg.. 1976;  44 580-584
• 12 Gower D J, Lewis J C. et al. . Sterile Shunt Malfunction. A Scanning Electron Microscope Perspective.  J. Neurosurg.. 1984;  61 1079-1084
• 13 James H E, Tibbs P A. Diverse Clinical Applications of Percutaneous Lumboperitoneal Shunts.  Neurosurgery. 1981;  8 39-42
• 14 Medical Research Council .Aids to the Examination of the Peripheral Nervous System. Memorandum No. 45: Her Majesty's Stationary Office 1976
• 15 Nitescu P, Karlsson P-A. et al. . No Signs of Local Neurotoxicity in Cancer Pain Patients treatet with Long-Term Subarachnoid Infusions of Morphine with Preservatives (Sodium Metabisulfite and Sodium Edetate) and Bupivacaine.  Eur. J. Pain. 1992;  13 77-88
• 16 North R B, Cutchis P N. et al. . Spinal Cord Compression complicating Subarachnoid Infusion of Morphine: Case Report and Laboratory Experience.  Neurosurgery. 1991;  29 778-784
• 17 Passon M, Schwittmann B. Inkomplettes Querschnittsyndrom nach Katheterimplantation zur rückenmarksnahen Opiatapplikation.  Der Schmerz.. 1992;  6 [Suppl] 13
• 18 Penn R D, Paice J A. Chronic Intrathecal Morphine for Intractable Pain.  J. Neurosurg.. 1987;  67 182-186
• 19 Plummer J L, Cherry D A. et al. . Long-term Spinal Administration of Morphine in Cancer and Non-Cancer Pain: A retrospective Study.  Pain. 1991;  44 215-220
• 20 Rekate H L, Ruch T. et al. . Diphteroid Infections of Cerebrospinal Fluid Shunts. The Changing Pattern of Shunt Infection in Cleveland.  J. Neurosurg.. 1980;  52 553-555
• 21 Tutak U, Doleys D M. Intrathecal Infusion Systems for Treatment of Low Back and Leg Pain of Noncancer Origin.  South Med. J.. 1996;  89 295-300
• 22 Sjöberg M, Karlsson P A. et al. . Neuropathologic Findings after Long-term Intrathecal lnfusion of Morphine and Bupivacaine for Pain Treatment in Cancer Patients.  Anesthesiology. 1992;  76(2) 173-186
• 23 Winkelmüller M, Winkelmüller M. Long-term Effects of Continuous Intrathecal Opioid Treatment in Chronic Pain of Nonmalignant Etioloy.  J. Neurosurg.. 1996;  85 458-467
• 24 Yaksh T L, Rudy T A. Chronic Catheterization of the Spinal Subarachnoid Space.  Physiol. Behav.. 1976;  17 1031-1103
• 25 Yaksh T L. Spinal opiate analgesia: Characteristics and Principles of Action.  Pain.. 1981;  11 293-334