Continuous intrathecal morphine infusion for pain management in a patient with burn injury

Abstract

Introduction: Known risk factors for delirium include admission to an intensive care setting and administration of intravenous infusions for pain and sedation. Patients diagnosed with delirium are more likely to have a prolonged ICU length of stay, increased ventilator days, and higher rates of long-term cognitive dysfunction. There is currently no effective treatment for delirium. Methods: This case report details the placement of an intrathecal catheter and infusion of intrathecal preservative-free morphine for the treatment of pain following burn injury. Results: During intrathecal infusion of morphine, the patient reported adequate pain control without systemic opioid administration. After intravenous infusions of ketamine, propofol, and dexmedetomidine were discontinued, the patient was awake and responsive. Following removal of the intrathecal morphine infusion, the patient’s opioid requirement remained lower than that needed prior to catheter placement, despite repeated surgical interventions. Discussion: Intrathecal opioid administration is a new direction in the treatment of acute pain in the intensive care setting and represents a way to reduce the risk of delirium by limiting exposure to systemic opioids and sedatives. There are no prior reports of intrathecal infusions in this population to directly compare, and therefore, any data on complications or infectious risk must be extrapolated from patients with different disease processes but similar interventions.