Table 2.

2012 Polyanalgesic Consensus Committee recommendations for intrathecal medication in nociceptive pain management

Line 1	Morphine	Hydromorphone	Ziconotide	Fentanyl
Line 2	Morphine + bupivacaine	Ziconotide + opioid	Hydromorphone + bupivacaine	Fentanyl + bupivacaine
Line 3	Opioid (morphine, hydromorphone, or fentanyl) + clonidine		Sufentanil
Line 4	Opioid + clonidine + bupivacaine		Sufentanil + bupivacaine or clonidine
Line 5	Sufentanil + bupivacaine + clonidine

Notes: Line 1: Morphine and ziconotide are approved by the US Food and Drug Administration for IT therapy and are recommended as first-line therapy for nociceptive pain. Hydromorphone is recommended on the basis of widespread clinical use and apparent safety. Fentanyl has been upgraded to first-line use by the consensus conference. Line 2: Bupivacaine in combination with morphine, hydromorphone, or fentanyl is recommended. Alternatively, the combination of ziconotide and an opioid drug can be employed. Line 3: Recommendations include clonidine plus an opioid (ie, morphine, hydromorphone, or fentanyl) or sufentanil monotherapy. Line 4: The triple combination of an opioid, clonidine, and bupivacaine is recommended. An alternate recommendation is sufentanil in combination with either bupivacaine or clonidine. Line 5: The triple combination of sufentanil, bupivacaine, and clonidine is suggested. Copyright 2012. Reproduced from John Wiley & Sons, Inc. Deer TR, Prager J, Levy R, et al. Polyanalgesic Consensus Conference 2012: Recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation. 2012;15:436–466.¹⁸