• PisanskyAndrew J BAJBDivision of Pain Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; Twin Cities Pain Clinic, Edina, MN, USA., Benjamin J MacDougall, Edgar L Ross, John H Chi, Grace Neville, and Tony L Yaksh.
• Division of Pain Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; Twin Cities Pain Clinic, Edina, MN, USA.
• Neuromodulation. 2024 Oct 1; 27 (7): 114011481140-1148.

ObjectivesIntrathecal opioids delivered by implanted pumps are used to treat malignant or nonmalignant chronic pain. In this study, we 1) review a case in which intrathecal infusions of sufentanil along with other adjuvants were used and after an extended period led to an intrathecal mass and 2) compared and contrasted the potential mechanisms for these phenomena.Materials And MethodsA woman aged 66 years with a history of scoliosis and multiple spine surgeries was treated with an implantable drug delivery system for treating persistent pain after laminectomy. The patient received intrathecal medication comprising sufentanil, bupivacaine, and clonidine.ResultsIntrathecal therapy over approximately ten years served to reduce pain and improve function over the treatment period. After the extended treatment interval, the patient developed an intrathecal mass that was associated with impairment. The mass was surgically removed. Systematic histopathology revealed the space-occupying mass to largely comprise fibroblasts and some inflammatory cells embedded in a collagen mass located proximally to the catheter tip.ConclusionsTo our knowledge, this is the first published case report of sufentanil causing this complication. The science and mechanism of intrathecal catheter tip-associated mass formation and associated clinical research correlates are reviewed in detail, and explanations for this phenomenon are proposed based on histochemical analysis of the patient's pathology findings.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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