Intrathecal bupivacaine monotherapy in patients with chronic refractory localized pain: a case series.

Abstract

Bupivacaine is an established agent in intrathecal drug delivery (IDD), often used in combination with opioids. The efficacy of intrathecal bupivacaine monotherapy has not been reported. A retrospective case series review was undertaken examining patients with chronic pain who underwent device implants and were receiving intrathecal bupivacaine monotherapy. Data collection included patient demographics as well as pain and IDD characteristics. Five patients receiving intrathecal bupivacaine monotherapy were identified. All patients had regionally localized pain. Duration of IDD ranged from >2 to >12 years. Two of the patients had initially received a combination of an opioid with bupivacaine but were later transitioned to intrathecal bupivacaine monotherapy. Three of the patients were on systemic opioids prior to IDD. All patients experienced ≥50% pain relief and discontinued systemic opioids. IDD with bupivacaine monotherapy may be effective in patients with localized pain. However, more studies are needed to establish the safety and efficacy of intrathecal bupivacaine monotherapy.