Patient under treatment by the Pain Unit suffering from chronic pain due to polytrauma with spinal trauma and T7 posterior arch fracture.
Located in the first consultation in the Pain Unit, dorsalgia, with mixed characteristics, with location between D2 and D7 dermatomes, and sometimes punctual, irradiation of neuropathic characteristics to lower limbs.
9.
It was decided to place an intrathecal infusion system that maintained 20 ml Syned II Medtronic for two years.
Good pain control with maximum VAS of 4 points in the reloading periods.
The patient slowly complained of more pain and increased doses of morphine, which initially were 4 mg a day, up to 16 mg/day plus bupivacaine 12 mg/day.
Although pain control was still acceptable, maintaining the VAS of 4 points, the geographical spread characteristic of Extremadura, and the high doses of drug required, decided to recharge the most frequent system for each reason 40 ml.
Under local anesthesia and sedation, partial obstruction of the multiperforated catheter is evident during the process, which is why the entire intrathecal system is changed in the same procedure.
The immediate postoperative period is uneventful and intrathecal drug doses are maintained with good analgesic level.
72 hours after the procedure, the patient presented with fever, leukocytosis with significant left shift and purulent secretion through the spinal access, without signs of meningism.
She underwent emergency surgery, with abundant pus in the pocket and spinal access.
The entire system is removed, broad-spectrum intravenous antibiotics (ceftazidime, vancomycin and rifampicin) are prescribed and a patient is admitted to the Resuscitation Unit with an abrupt infusion strategy consisting of midazolam over 125 mg.
Rescue neurostimulation is considered when withdrawal syndrome (thiaprizal and/or haloperidol) appears.
