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 73% 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.