Michael Ashley, Fuller Timothy, Brogan Shane, Murphy Mary Casey
Interventional Pain Physician, Summit Health, Bend, Oregon, USA.
Department of Emergency Medicine, University of Utah, Salt Lake City, Utah, USA.
J Palliat Med. 2025 Jul;28(7):990-993. doi: 10.1089/jpm.2024.0130. Epub 2025 Jan 30.
We present a case of a patient with an intrathecal pump who experienced an unrecognized partial pocket fill, leading to an atypical opioid withdrawal characterized by akathisia. A 57-year-old female with multiple myeloma presented to an emergency department with new-onset akathisia requiring admission. Eight weeks prior, her intrathecal pump was refilled with morphine, bupivacaine, and ziconotide. After a thorough evaluation, her pump reservoir was found to be empty despite an expected residual volume of 10 mL. Furthermore, she reported sedation following her last pump refill, all consistent with an unrecognized partial pocket fill followed by an unusual opioid withdrawal presentation. This case represents an example of both an unrecognized partial pocket fill and an atypical presentation of opioid withdrawal manifesting as akathisia. Furthermore, this patient's case may be considered a medical error given the serious morbidity that can be associated with inadvertent pocket fills.
我们报告了一例鞘内注射泵患者的病例，该患者经历了未被识别的部分囊袋填充，导致以静坐不能为特征的非典型阿片类药物戒断反应。一名57岁的多发性骨髓瘤女性因新发静坐不能到急诊科就诊，需要住院治疗。八周前，她的鞘内注射泵重新填充了吗啡、布比卡因和齐考诺肽。经过全面评估，发现她的泵储液器为空，尽管预期残留量为10毫升。此外，她报告说在最后一次泵重新填充后出现了镇静，所有这些都与未被识别的部分囊袋填充以及随后出现的异常阿片类药物戒断表现一致。该病例代表了未被识别的部分囊袋填充以及表现为静坐不能的阿片类药物戒断非典型表现的一个例子。此外，考虑到与意外囊袋填充相关的严重发病率，该患者的病例可能被视为医疗差错。
