469: Successful Long-Term Intrathecal Catheter Adapted as a Lumbar Drain Connected to Infusion Pump

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic cancer related pain, Psychology, Developing methodology/technology, Pain in Special Populations

Background and Aims: Malignant sacral involvement can cause severe pain that is challenging to manage with analgesics alone. Intrathecal drug delivery systems (IDDS) offer an effective alternative but often involve implanted pumps. We present a case where an intrathecal catheter, typically used as a lumbar drain, was successfully adapted for long-term use with an external pump to manage cancer pain.
A 54-year-old male with a recurrent rectosigmoid adenocarcinoma and sacral metastasis presented with severe, constant burning pain in the lower back, buttocks, and lower extremities, associated with feet paresthesia. Pain was exacerbated by movement and impacted his sleep and mood. Imaging revealed a 6cm recurrent tumor invading the sacral foramina and involving the sacral nerve roots. His pain remained poorly controlled despite high-dose opioids (Morphine Sulfate Tablet-Sustained Release (MST) 40 mg TID, Morphine Immediate Release (MIR) 10 mg, Methadone 5 mg PO BID) and adjuvants, leading to frequent hospital admissions and ER visits.

Methods: After a multidisciplinary discussion and informed patient consent, an intrathecal catheter (Lumbar Drainage Kit, Medtronic™) was inserted at the L2-L3 level under sedation and fluoroscopic guidance, with its tip positioned at T9 (Fig.2). The catheter was tunneled subcutaneously and connected to an external ambulatory infusion pump (CADD-Solis™) via a 0.2-micron filter. A continuous infusion of bupivacaine 0.5 mg/mL and fentanyl 10mcg/ml was initiated. Catheter site care was performed by the family using Chlorhexidine Gluconate dressings (3M Tegaderm™), changed every 7-10 days.

Results: The intrathecal analgesia provided sustained pain relief for 66 days, achieving a 50% reduction in pain scores and a 30% reduction in oral opioid requirements. The patient's sleep and ability to move in bed improved. Most notably, his frequent emergency room visits and hospital admissions were eliminated entirely. No signs of catheter-related infection or dislodgement occurred (Fig. 3).

Conclusions: This case demonstrates that adapting an intrathecal lumbar drain catheter for use with an external infusion pump is a feasible, safe, and effective strategy for providing long-term palliative pain control in select patients. This approach, combined with meticulous family-led catheter care, can significantly improve patient quality of life and reduce the burden on acute healthcare services.

References: References:
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Presenting Author: Mohammad Ghalib Riziq
Submitting Author: Mohammad Riziq

Senior Author: Mohammad Ghalib Riziq

IASP 2026 Global Year theme of Neuropathic Pain: Yes