Intrathecal Bupivacaine and Clonidine for Refractory Hyperhidrosis in Spinal Cord Injury

Introduction: Autonomic dysreflexia (AD) in spinal cord injury (SCI) can present as hyperhidrosis due to sudomotor dysfunction. There are no standard treatment guidelines for refractory hyperhidrosis due to persistent noxious stimulation. Case: A 58-year-old female with C7 ASIA-A quadriplegia was admitted to the hospital in 2018 for T7-8 discitis. Discitis acted as a noxious stimulus manifesting clinically as autonomic dysreflexia. On average, she experienced 50-60 sweating episodes every day. She underwent serial stellate ganglion blocks with >75% improvement which provided 9 months of continued relief. Patient transitioned to intrathecal bupivacaine 2.5mg/ml + Clonidine 200mcg/ml with the catheter tip located at C4-5 in 2019. She is maintained on Bupivacaine 0.2mg + Clonidine 20mcg/24hrs. Results: Patient reports near complete resolution of hyperhidrosis following implantation of intrathecal pump. She is back to her baseline, independent with ADL”s using manual wheelchair. Conclusion: To our knowledge, this is a first reported case of successful resolution of hyperhidrosis using intrathecal pump. Bupivacaine and clonidine may be a viable treatment option for not only refractory hyperhidrosis, but also AD in SCI patients.