We report a case in which the signs of a malignant meningitis could have been confused with complications of an in-dwelling epidural catheter which was being used for analgesia. This confusion could have had disastrous implications for the patient's pain relief. We also discuss some of the issues and problems surrounding the use of in-dwelling epidurals in terminal care patients.
Plummer JL, Cherry DA, Cousins MJ, Gourlay GK, Onley MM, Evans KHLong-term spinal administration of morphine in cancer and non-cancer pain: a retrospective study. Pain1991; 44: 215-20.
2.
Crawford ME, Andersen HB, Austenborg G. et al. Pain treatment on an out-patient basis utilizing extradural opiates. Pain1983; 16: 41-47.
3.
Gustafsson LL , Johannison J., Garle M.Extradural and parenteral pethidine as analgesia after THR. Eur J Clin Pharmacol1986; 29: 529-34.
4.
Hogan Q., Haddox JD, Abram S., Weissman D., Taylor ML, Janjan N.Epidural opiates and local anaesthetics for the management of cancer pain . Pain1991; 46: 271-79.
5.
DuPen SL, Peterson DG, Williams A., Bogosian AJInfection during chronic epidural catheterization: diagnosis and treatment . Anesthesiology1990; 73: 905-909.
6.
Yap KB, Finlay IGEpidural infection associated with epidural catheterization in a cancer patient with back pain: case report. Palliat Med1994 ; 8: 251-53.
7.
Byers K., Axelrod P., Michael S., Rosen S.Infections complicating tunnelled intraspinal catheter systems used to treat chronic pain. Clin Infect Dis1995; 21: 403-408.
8.
Coombs DW, Maurer HL, Saunders RL, Gaylor M.Outcome and complications of continuous intraspinal narcotic analgesia for cancer pain control. J Clin Oncol1984; 2: 1414-20.
Findlay GF, Owen R.Surgery of the spine. Oxford: Blackwell Scientific, 1992: 621-28.
12.
Peat S.Neural blockade in palliative care. Palliative Care Today1996; 5: 8-10.
13.
Downing JE, Busch EH, Stedman PMEpidural morphine delivered by a percutaneous epidural catheter for out-patient treatment of cancer pain. Anesth Analg1988 ; 67: 1159-61.
14.
Kendall B.How to do a cisternal puncture. Br J Hosp Med1980; 24: 571.
15.
Cox TC, Stevens JM, Kendall BEVascular anatomy in the suboccipital region and lateral cervical puncture . Br J Radiol1981; 54: 572-75.