Korean J Anesthesiol.  1988 Feb;21(1):222-226. 10.4097/kjae.1988.21.1.222.

Transient Cauda Equinal Irritation due to the Subarachnoid Spread of Epidural Morphine Through a Previous Dural Puncture Site

• Jin YH
• Lim SH
• Kim KS
• Choe H

• KMID: 2239508
• DOI: http://doi.org/10.4097/kjae.1988.21.1.222

Abstract

Signs and Symptoms consistent with the irritation of the cauda equina developed during epidural morphine therapy for the relief of pain from osteosarcoma in a 10-year-old female patient. This was considered to be due to a subarachnoid diffusion of the epidurally administrated morphine through the dural opening formed by a previous inadvertent dural puncture. The subarachnoid diffusion of the drug was confirmed by fluoroscopy following injection of the contrast media through the indwelling epidural catheter. The chemical inflammation of the cauda equina might be due to substances formed by chemical reactions with a certain preservative vehicle rather than the morphine itself. Spinal steroid therapy may be effective for the suppression of a chemical inflammatory reaction.

Keyword

Epidural morphine-pain control; subarachnoid morphine-cauda equina syndrome

MeSH Terms

Catheters
Cauda Equina
Child
Contrast Media
Diffusion
Female
Fluoroscopy
Humans
Inflammation
Morphine*
Osteosarcoma
Punctures*
Contrast Media
Morphine