J A Aldrete1, S K Williams. 1. Health Destinations, The Institute for the Study of Treatment of Arachnoiditis, Santa Rosa Beach, Florida 32459, USA.
Abstract
BACKGROUND AND OBJECTIVES: Patients with severe and noncancer pain were treated with prolonged epidural infusions of analgesics in their homes, and the incidence of infection was determined. METHODS: In 504 adult patients, 3,164 polyamide lumbar epidural catheters were infused with analgesics of low-dose bupivacaine and fentanyl intermittently from 2 to 80 days at their home. When patients developed fever, headache, back pain, and leukocytosis, the presence of infection was confirmed by either computed tomographic scan, epidurogram, or sonogram. RESULTS: Nine infections (0.27%) occurred. Of these, two were epidural abscesses, two were fascitis, and five were cellulitis. Staphylococcus epidermidis was cultured in every case. All of them were treated with 1.5 g intravenous cefuroxime sodium every 8 hours. None of the patients required surgical intervention. In a subgroup of patients treated with the first 1,462 infused catheters, seven infections developed (0.4%), whereas in the subsequent 1,702 cases that received prophylactic penicillin or erythromycin, in 6-day cycles, there were only two infections (0.11%). CONCLUSIONS: Temporary epidural infusions of analgesics up to 80 days are feasible in ambulatory patients with a low rate of infections. Preliminary observations appear to indicate that prophylactic antibiotics given intermittently further reduce the feasibility of infections. However, these observations may not apply to longer-lasting epidural infusions.
BACKGROUND AND OBJECTIVES:Patients with severe and noncancer pain were treated with prolonged epidural infusions of analgesics in their homes, and the incidence of infection was determined. METHODS: In 504 adult patients, 3,164 polyamide lumbar epidural catheters were infused with analgesics of low-dose bupivacaine and fentanyl intermittently from 2 to 80 days at their home. When patients developed fever, headache, back pain, and leukocytosis, the presence of infection was confirmed by either computed tomographic scan, epidurogram, or sonogram. RESULTS: Nine infections (0.27%) occurred. Of these, two were epidural abscesses, two were fascitis, and five were cellulitis. Staphylococcus epidermidis was cultured in every case. All of them were treated with 1.5 g intravenous cefuroxime sodium every 8 hours. None of the patients required surgical intervention. In a subgroup of patients treated with the first 1,462 infused catheters, seven infections developed (0.4%), whereas in the subsequent 1,702 cases that received prophylactic penicillin or erythromycin, in 6-day cycles, there were only two infections (0.11%). CONCLUSIONS: Temporary epidural infusions of analgesics up to 80 days are feasible in ambulatory patients with a low rate of infections. Preliminary observations appear to indicate that prophylactic antibiotics given intermittently further reduce the feasibility of infections. However, these observations may not apply to longer-lasting epidural infusions.