Physicians' Pain Specialists of Alabama, Mobile, Alabama 36607, USA.
Pain Med. 2010 Jun;11(6):972-6. doi: 10.1111/j.1526-4637.2010.00854.x. Epub 2010 Apr 29.
Lower-limb edema is recognized as an untoward side effect of intrathecal opioid therapy. Cellulitis, an acute, spreading pyogenic inflammation of the dermis and subcutaneous tissue, predisposed by persistent leg edema, can become problematic in patients on intraspinal opioid infusion therapy.
To present a case of recurrent cellulitis in an elderly lady with persistent leg edema associated with intrathecal morphine/hydromorphone infusion therapy.
Sixty-one-year-old woman with intractable chronic low back pain and bilateral leg pain treated with an intrathecal infusion of morphine up to 5 mg/day over 3 months with satisfactory pain control developed progressive lower extremity edema, complicated by recurrent cellulitis, requiring repeated hospitalization and intravenous antibiotic treatment. Switching to intrathecal hydromorphone helped minimally. Intrathecal baclofen and clonidine infusion resulted in complete resolution of leg edema and pain relief over the following 12 months.
Intrathecal Baclofen and Clonidine may be used as alternatives to provide spinally mediated antinociception when intraspinal opioid fails due to pharmacological side effects such as persistent edema.
下肢水肿是鞘内阿片类药物治疗的一种不良副作用。蜂窝织炎是一种由持续的腿部水肿引起的急性、弥漫性化脓性真皮和皮下组织炎症，如果发生在接受椎管内阿片输注治疗的患者身上，可能会成为一个问题。
介绍一例老年女性因鞘内吗啡/氢吗啡酮输注治疗相关持续性腿部水肿而反复发作蜂窝织炎的病例。
一名 61 岁女性，患有顽固性慢性腰痛和双侧腿部疼痛，接受鞘内输注吗啡，每天高达 5 毫克，持续 3 个月，疼痛得到了满意的控制，但出现进行性下肢水肿，并发反复发作的蜂窝织炎，需要反复住院和静脉内抗生素治疗。改用鞘内氢吗啡酮治疗效果甚微。鞘内巴氯芬和可乐定输注治疗在接下来的 12 个月内完全缓解了腿部水肿和疼痛。
当椎管内阿片类药物因药理副作用（如持续水肿）而失效时，鞘内巴氯芬和可乐定可作为替代药物，提供脊髓介导的镇痛作用。
