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Serious complications associated with external intrathecal catheters used in cancer pain patients : a systematic review and meta-analysis

Aprili, Daniel and Bandschapp, Oliver and Rochlitz, Christoph and Urwyler, Albert and Ruppen, Wilhelm. (2009) Serious complications associated with external intrathecal catheters used in cancer pain patients : a systematic review and meta-analysis. Anesthesiology, Vol. 111, H. 6. pp. 1346-1355.

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Official URL: http://edoc.unibas.ch/dok/A6007578

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Abstract

BACKGROUND: Potential risks of intrathecal catheters in cancer patients include infection, bleeding, and neurologic injury. METHODS: A systematic review and a pooled analysis of observational studies were performed. Articles reporting on adverse events (infections, bleeding, granuloma, and death) associated with intrathecal catheters and external pumps in cancer patients were identified. Electronic searches of PubMed, MEDLINE, and EMBASE were conducted. Observations from different studies were pooled using a generalized mixed-effect model. Model estimates and their standard errors (SEs) were used for calculating 95% confidence intervals (CIs) on the overall proportion. RESULTS: The analysis identified 10 articles, including a total of 821 patients. Twenty catheter-related infections were identified. Of these, 10 were superficial and 10 were deep infections, with rates of 2.3% (95% CI, 0.8-6.1) and 1.4% (95% CI, 0.5-3.8), respectively. Furthermore, the authors calculated that every 71st patient had a deep infection after an average catheter duration of 54 days. The risk of bleeding was found to be 0.9% (95% CI, 0-2.0), and for neurologic injury 0.4% (95% CI, 0-1.0). The infection rates are comparable to other intrathecal catheter techniques. CONCLUSIONS: Serious complications are rare in both hospitalized and homebound patients with intrathecal catheters. This analysis supports the reasoning that the potential benefit of intrathecal catheters in the treatment of severe cancer pain is likely to outweigh the potential for serious complications associated with this technique. Therefore, an external intrathecal catheter can be considered an effective and low-cost solution for the control of pain in such patients.
Faculties and Departments:03 Faculty of Medicine > Bereich Querschnittsfächer (Klinik) > Anästhesiologie > Anästhesie und Intensivmedizin (Urwyler)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Querschnittsfächer (Klinik) > Anästhesiologie > Anästhesie und Intensivmedizin (Urwyler)
UniBasel Contributors:Rochlitz, Christoph and Urwyler, Albert
Item Type:Article, refereed
Article Subtype:Further Journal Contribution
Bibsysno:Link to catalogue
Publisher:American Society of Anesthesiologists
ISSN:0003-3022
Note:Publication type according to Uni Basel Research Database: Journal item
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Last Modified:15 Aug 2014 07:16
Deposited On:15 Aug 2014 07:16

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