Implanted intrathecal drug delivery systems provide excellent pain relief and reduced drug toxic-ity in patients with refractory cancer pain.1'2 Common complications include postpuncture headache (15%), external leakage of cerebrospinal fluid (3.5%), CSF hygroma (1.5%), catheter tip dislodgement (1.5%) and catheter system leakage (1.5%). Infection of implanted systems are a rare occurrence, mostly in the first 3 mo after implantation.3 We report a pump malfunction resulting from pump-catheter connection failure and a strategy to avoid this complication. A 72-yr-old patient with bladder cancer meta-static to the sacrum and lumbar plexus was receiving the equivalent of 750 mg morphine per day postop-eratively, but with significant sedation and still inadequate pain control. A percutaneous intrathecal catheter was placed and an infusion of morphine begun. The patient improved rapidly, showing much lower pain scores while being alert and mobile.
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