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首页> 外文期刊>The clinical journal of pain >Tunneled epidural catheter infections in noncancer pain: increased risk in patients with neuropathic pain/complex regional pain syndrome.
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Tunneled epidural catheter infections in noncancer pain: increased risk in patients with neuropathic pain/complex regional pain syndrome.

机译：非癌性疼痛中的隧道硬膜外导管感染：神经性疼痛/复杂性局部疼痛综合征患者的风险增加。

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BACKGROUND AND OBJECTIVE: Tunneled epidural catheters are often used to control pain and facilitate rehabilitation in patients with regional pain syndromes. A cohort retrospective study design was undertaken to evaluate the risk of catheter-related infection in patients who underwent a TEC placement to manage their chronic noncancer regional pain over a 5-year period. METHODS: There were 260 tunneled epidural catheters placed in 218 patients accounting for a total of 10,985 catheter-days. Of these, 230 catheters were placed in patients with neuropathic pain (90% of whom had complex regional pain syndrome) and 30 catheters in patients with somatic pain. RESULTS: There were 24 epidural space infections in symptomatic patients, 23 of whom were in the neuropathic pain group-22 had complex regional pain syndrome. Additionally, tunneled epidural catheters had to be discontinued in 34 patients because of superficial infection or suspicion of infection; 33 of these were in the neuropathic pain group. The differences in the infection rates were significantly higher in the neuropathic pain group compared to the somatic group. When analyzed to an infection index per 1,000 catheter-days, the rate of infection rate was 5.51 for the patients with neuropathic pain and 2.43 for the patients with somatic pain. The rates for deep and superficial infections were 2.26 and 3.25, respectively, per 1000 catheter-days for the neuropathic pain group compared to 1.22 for both deep and superficial infections in the patients with somatic pain. There were 6 frank epidural abscesses upon contrast-enhanced magnetic resonance imaging examinations of the spine, 1 epidural phlegmon and 2 patients displayed mild or questionable epidural enhancement on magnetic resonance imaging, suggestive of epidural inflammation. All these magnetic resonance imaging abnormalities were detected in patients with complex regional pain syndrome. Two of the patients with epidural abscesses underwent surgical exploration and drainage of the epidural abscess, though no neurologic deficits were observed in any of the patients. CONCLUSIONS: The higher risk of tunneled epidural catheter infection observed in patients with neuropathic pain (particularly complex regional pain syndrome) warrants further study.
机译：背景与目的：隧道硬膜外导管常用于控制疼痛并促进局部疼痛综合征患者的康复。进行了一项队列回顾性研究设计，以评估接受TEC放置以管理其慢性非癌性区域性疼痛超过5年的患者的导管相关感染的风险。方法：218例患者共放置260根硬膜外硬膜外导管，总计10985天。其中，在患有神经性疼痛的患者中放置了230个导管（其中90％患有复杂的局部疼痛综合征），而在患有躯体性疼痛的患者中放置了30个导管。结果：有症状患者中有24例硬膜外腔感染，其中22例神经病理性疼痛患者中有23例患有复杂的局部疼痛综合征。此外，由于浅表感染或怀疑感染，在34名患者中必须中断硬膜外导管。其中有33例属于神经性疼痛组。与躯体组相比，神经性疼痛组的感染率差异明显更高。以每1,000个导管日的感染指数进行分析，神经性疼痛患者的感染率为5.51，躯体疼痛患者的感染率为2.43。对于神经性疼痛组，每1000个导管日的深部和浅部感染发生率分别为2.26和3.25，而躯体性疼痛患者的深部和浅部感染发生率分别为1.22和3.25。脊柱对比增强磁共振成像检查发现有6例坦率的硬膜外脓肿，有1例硬膜外痰，2例患者的磁共振成像显示轻度或可疑的硬膜外增强，提示硬膜外炎症。所有这些磁共振成像异常均在复杂的区域性疼痛综合征患者中检测到。硬膜外脓肿中有2例接受了硬膜外脓肿的手术探查和引流，尽管在任何患者中均未见神经功能缺损。结论：在神经性疼痛（特别是复杂的区域性疼痛综合征）患者中观察到隧道硬膜外导管感染的较高风险值得进一步研究。

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