Persistent leakage of cerebrospinal fluid after intrathecal administration of morphine in an operation on the lumbar spine. A report of two cases.

Intrathecal administration of opioids has been described as being effective, safe, and simple’’; this technique has been used in operations on the abdomen, extremities, thorax, and spine. Proponents of the technique point out advantages compared with epidural administration: there is no indwelling catheter in the epidural space, and the dosage is ten to sixteen times smaller and the prevalence of respiratory depression is lower than with epidural anesthesia. Because intrathecally administered opioids are given in smaller doses, inadequate analgesia can be augmented with intravenous administration of opioids. Also, monitoring in an intensive-care unit may not be necessary’. Recently, morphine has been given intrathecally at our institution in selected patients who have an operation on the lumbar spine. The opioid has been injected through a 25-gauge Quincke needle (Becton-Dickinson, Rutherford, New Jersey) at the sites of laminotomies, before closure of the wound. Between the beginning of September 1991 and the end of February 1992, twentysix patients in our hospital were given morphine intrathecally during an operation on the lumbar spine. We report here two complications that were a direct result of this method of anesthesia: a persistent leak of cerebrospinal fluid with dehiscence of the wound, and formation of a pseudomeningocele. To our knowledge, no wound complications with this technique have been reported previously.