Abstract
Epidural and intrathecal drug delivery systems are used chronically for the management of intractable pain. Complications of these systems include infection, drug-related toxicities, and mechanical failure of the device. A working understanding of these potential complications is necessary for the clinician to be successful in avoiding these sequelae when possible, and identifying and managing difficulties when they arise. This report examines the literature in the area of complications of intraspinal devices. Infection of externalized indwelling epidural catheters occurs at a rate of 5% to 12% and is a result of contaminated infusate, spread along the catheter track, or hematologic seeding. Contaminated infusate is likely related to the number of times the system is “opened” for bag, tubing, or filter changes. The use of epidurally-infused vancomycin as a catheter sterilization technique is explored in a 53-year-old cancer patient. A review of the literature available on device-related meningitis is presented. Spinal drug related toxicities range from simple side-effects, to hormonal suppression, and preservative-induced injury. Mechanical complications including pump and catheter failure are reviewed.
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