Journal of Japan Society of Pain Clinicians

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Intrathecal analgesia (IA) is an effective method of pain control for patients with refractory cancer pain. However, IA needs to arrange local anesthetics for each patient to have an appropriate analgesia. The authors present a case report in which we controlled the baricity of intrathecal drugs and achieved sufficient analgesia. A 47-year-old woman reported severe lumbar pain due to multiple bone metastases following rectal cancer surgery. Opioids produced insufficient analgesia and drowsiness, resulting in decreased activity of daily life. We offered IA with the catheter tip in L1, and administrated isobaric bupivacaine. The pain disappeared at rest, but appeared on movement. The IA therapy using isobaric bupivacaine also provided urinary retention and muscle weakness in legs. Therefore, we gradually increased the baricity in combination with hyperbaric bupivacaine, and presented sufficient analgesia for exertional pain without urinary retention and motor weakness. Increasing baricity may shift local anesthetics from anterior root (motor nerves) to posterior root (sensory nerves) in intrathecal space.

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