HYPERALGESIA INDUCED BY HIGH-DOSE INTRATHECAL SUFENTANIL IN NEUROPATHIC PAIN

The patient had lower lumbar arachnoiditis as part of a failed back su rgery syndrome. Two years after discectomy, she still suffered from le ft lumbosciatic pain despite various invasive treatments. Psychologic impairment could be excluded, Finally intrathecal morphine was infused at the D12 level. Small amounts of morphine (500-750 mg daily) introd uced intolerable vomiting, which could not be prevented by antiemetics , so intrathecal sufentanil was started. A daily dose of 25 mg of sufe ntanil diluted in 1.5 ml of saline evoked hyperalgesia in the lower pa rt of the body, Increasing the dose to 50 mg, daily could only be supp orted for 3 h. Sufentanil was stopped and saline started, alter which the evoked hyperalgesia disappeared, It is concluded that relatively h igh doses of sufentanil may induce hyperalgesia in patients with arach noiditis and neuropathic pain.