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Palliative Medicine
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case-report

To replace or not to replace? – Partial coning and a sixth nerve palsy secondary due to displacement of a tunnelled intrathecal catheter for pain control

J Gibbins

The Macmillan Unit, North Bristol NHS Trust, Frenchay Hospital, Frenchay Park Road, Bristol, janegibbins{at}hotmail.com

C Steeds

The Pain Clinic, Macmillan Unit, North Bristol NHS Trust, Frenchay Hospital, Frenchay Park Road, Bristol

GL Greenslade

The Pain Clinic, Macmillan Unit, North Bristol NHS Trust, Frenchay Hospital, Frenchay Park Road, Bristol

SR Tunstall

The Macmillan Unit, North Bristol NHS Trust, Frenchay Hospital, Frenchay Park Road, Bristol

NK Patel

Department of Neurosurgery, North Bristol NHS Trust, Frenchay Hospital, Frenchay Park Road, Bristol

CF Stannard

The Pain Clinic, Macmillan Unit, North Bristol NHS Trust, Frenchay Hospital, Frenchay Park Road, Bristol

We report the displacement of a tunnelled intrathecal catheter causing significant cerebrospinal fluid (CSF) leak, resulting in partial coning and a sixth nerve palsy. The patient had advanced malignant mesothelioma and all other methods of pain control had been unsuccessful. As far as we are aware, there are no published reports of early replacement of an intrathecal catheter in patients with neurological sequelae. Surgical re-siting of the intrathecal catheter produced good pain relief for many months. Doctors involved in the use of indwelling intrathecal catheters for pain control must be aware of the risk of significant neurological sequelae but should not dismiss re-establishment of intrathecal therapy in the presence of significant neurological complications.

Key Words: intrathecal analgesia • cancer pain • intrathecal complications

Palliative Medicine, Vol. 22, No. 5, 668-670 (2008)
DOI: 10.1177/0269216308091558
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