Optimizing intrathecal pain relief in palliative care Authors: Greger Fransson, MD, Maria Olsson, RN A method for intrathecal pain relief is described by Petre Nitesscu 1997 using Morphin and Bupivacainhydrchloride in a catheter penetrating the skin. Working as a palliative consultant team in an area of approximitely 60 000 people we have used the intrathecal approach in 20 cases over 2.5 years. The tip of the catheter was placed in the center of the pain area (Th 4-L4). The concentration and volume of local anestetic was individualized. The goal was to achieve effective pain control without having any motorblock. The total intake of opioids was systematically recalculated to intrathecal doses meaning no other opioids were given except for Morphine-Scopolamin during the last days. The goal for volume to be given was 0.5 ml per hour making it possible to use a lightweight infusionpump with good electronics including patient controlled analgesia function (Gemstar) with capacity for one week including the need for bolusdoses. Finally the setup was improved by after tunneling connecting the catheter to a port-a-cath subcutaneosly on the anterior chest wall (Cellsite/Braun). This made it possible to have active patients (including paddling the canot) in their homes with a minimum of opioid side affects like confusion except for one patient who had been in bed 3 months previously. They had their catheters 8-223 days (median 34, mean 59) before dying. The major advantage of the use of a port-a-cath instead of letting the catheter penetrate the skin is the nursing and bandaging. There were no catheter dislocations. One patient was treated with intravenous antibiotics due to a possible intratechal infection without removing the catheter and no positive culture and another patient got a profylactic oral antibiotic due to a skin infection on top of the port.