A COMPARISON OF EPIDURAL CATHETERS WITH OR WITHOUT SUBCUTANEOUS INJECTION PORTS FOR TREATMENT OF CANCER PAIN

The aim of this study was to compare the incidence of technical compli cations of epidural catheters with subcutaneous injection ports to per cutaneous epidural catheters without ports, fixed only by adhesive dre ssing. We reviewed 149 patients who received 250 epidural catheters fo r treatment of cancer pain during a 3 1/2-yr period from January 1, 19 89, to June 30, 1992. Of the 250 catheters, 52 were provided with subc utaneous injection ports and 198 were percutaneous catheters. Of the 1 98 percutaneous catheters, 41 were tunneled for a short distance; the remainder entered the skin at the dorsal midline. In the percutaneous group 21% of the catheters became dislodged. In the injection port gro up, there were no catheter dislodgements. The overall incidence of inf ections was similar in both groups (13.6%). When we indexed the infect ion rate to catheter-days, the number of infections per 1000 catheter- days in the injection port group was half that of the percutaneous gro up (2.86 infections versus 5.97 for percutaneous catheters). No inject ion port became infected during the first 70 days of treatment, wherea s in the percutaneous group infections occurred as early as the first week. Within the percutaneous group the complication rate in the tunne led epidural catheters was as high as in the nontunneled. We conclude that injection ports reduce the complication rate of epidural catheter s, particularly catheter dislodgement and early infections.