Intrathecal infusion of bupivacaine with or without buprenorphine relieved intractable pain in three patients with vertebral compression fractures caused by osteoporosis

Abstract

Background and Objectives. At present, there is no reliable method of relieving “refractory” pain in patients with compression fractures of the vertebral bodies caused by osteoporosis. We explored the possibility of relieving this type of pain by intrathecal (IT) infusion of bupivacaine with or without buprenorphine. Methods. An 18-g nylon IT catheter was inserted via a lumbar interspace with its tip positioned at the level of the fractured vertebra from which the maximal pain originated. Bupivacaine (2.375-5.0 mg/mL) with (n = 1) or without (n = 2) buprenorphine (0.015 mg/mL) was infused through the IT catheter from an external electronic pump. The infusion began in the operating room at a basic rate of 0.1-0.2 mL/h, with optional bolus doses (0.1 mL, 1–4 times/h) via patient controlled analgesia. The daily dose of IT bupivacaine was adjusted to provide satisfactory pain relief [visual analogue scores (VAS) = 0–2 on a scale of 0–10]. Results. Satisfactory pain relief was obtained with daily doses of IT bupivacaine ranging from 10 to 70 (mean ≈25) mg and buprenorphine from 0.02 to 0.2 (mean = 0.15) mg. The duration of IT treatment was 37, 387, and 407 days, respectively. Two patients terminated the IT treatment when it was no longer needed. Treatment was discontinued in the third patient because of death caused by irreversible heart failure. The 2 surviving patients were still free of pain 1,074 and 1,476 days after termination of the IT treatment. No severe complications occurred. Conclusions. Continuous intrathecal infusion of bupivacaine, with or without buprenorphine, appeared to be an effective method for the long-term treatment (months to >1 year) of “refractory” pain from vertebral compression fractures, in this small group of patients.