Cervical radiculopathy treated by infusion of epidural analgesics in homebound patients.

STUDY

OBJECTIVE

To determine the efficacy and safety of administering low-dose analgesic infusions through cervical epidural catheters.

DESIGN

Retrospective review of medical records.

SETTING

Community hospital.

PATIENTS: 14 ambulatory adult patients with chronic cervical radiculopathy due to posttraumatic or osteoarthritic degenerative disk disease persisting after steroid epidural blocks.

INTERVENTIONS: 42 catheters were inserted into the cervical epidural space and infused with low-dose fentanyl-bupivacaine mixtures continuously for 2 to 17 days. To prevent side effects, the optimal dose was reached by upgrade adjustments. After catheter insertion, patients were observed for 6 to 21 days for dose adjustment, then discharged home and followed by homecare nurses. After removal of catheters, patients were followed for 8 to 10 days. If pain intensity returned to control levels, other treatment was initiated.

MEASUREMENTS AND MAIN

RESULTS

After each catheter treatment, pain intensity was reduced in 79% of the cases. Upon completion of the therapy, 5 patients had 50% to 75% of their pain reduced. Eight patients experienced 75% or more reduction of their original pain. The most common complications were nausea (35.7%) and pruritus (27%). One case of cellulitis was treated with antibiotics. There were no instances of respiratory compromise.

CONCLUSIONS

Patients with chronic persistent cervical radiculopathy pain were effectively treated with infusion of analgesics through epidural catheters for 2 to 17 days while they were at home.