Successful long-term palliative pain management using an intrathecal catheter adapted as a lumbar drain connected to an external infusion pump: A case report.

Introduction: Malignant sacral involvement can cause severe, refractory pain that remains challenging to manage with systemic analgesics alone. Intrathecal drug delivery systems (IDDS) offer an effective alternative but often involves surgically implanted pumps. We present a case in which an intrathecal catheter, typically used as a lumbar drain, was successfully adapted for long-term use with an external pump to manage intractable cancer pain. Case presentation: A 54-year-old male with a history of recurrent rectosigmoid adenocarcinoma and sacral metastasis presented to the pain clinic with complaints of burning and tight pain in the lower back, buttocks, and lower extremities, associated with bilateral foot paresthesias. Pain was exacerbated by movement and significantly impacted sleep and mood. Imaging revealed a 6cm recurrent tumor invading the sacral foramina and involving the sacral nerve roots. The patient's pain remained poorly controlled despite high-dose opioids (Morphine Sulfate Tablet-Sustained Release (MST) 40 mg TID, Morphine Immediate Release (MIR) 10 mg PRN, Methadone 5 mg PO BID) and adjuvants, leading to frequent hospital admissions and emergency room (ER) visits. Intervention: After a multidisciplinary discussion and obtaining 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. The catheter was tunneled subcutaneously and connected to an external ambulatory infusion pump (CADD-Solis™) via a 0.2-μm filter. A continuous infusion of bupivacaine 0.5mg/mL and fentanyl 10mcg/mL was initiated. Catheter site care was performed by the family using Chlorhexidine Gluconate dressings (3M Tegaderm™), which were changed every 7-10 days. Outcome: The intrathecal analgesia provided sustained pain relief for 66 days, achieving a 50% reduction in pain scores and a 30% reduction in systemic opioid requirements. The patient's sleep quality and ability to reposition in bed improved. Most notably, the frequent ER visits and hospital admissions were eliminated. No signs of catheter-related infection or dislodgement occurred. Conclusion: This case demonstrates that adapting an intrathecal lumbar drain catheter for use with an external infusion pump is a feasible and effective strategy for providing long-term palliative pain control in selected patients with a good safety profile. This approach, combined with meticulous family-led catheter care, can significantly improve patients' quality of life and reduce the burden on acute healthcare services.