Original ContributionsComplications of Intrathecal Drug Delivery Systems
Section snippets
INTRODUCTION
Although systemic opioids are effective in nonmalignant pain management, they can be associated with significant side effects (1). The majority of adverse drug reactions are dose-related and occur in patients taking standard doses of medications. These facts suggest that for many patients, standard drug doses may be excessive. Moreover, oral medications may not be effective in controlling pain. The efficacy and cost effectiveness of intrathecal medications for the treatment of chronic pain is
PATIENTS AND METHODS
We retrospectively reviewed our pump implant database for complications related to the implantation of intrathecal drug delivery systems. One physician (BW) performed all implants and another physician (SK) and a nurse collected data. Data collection involved filling a detailed questionnaire that included a section for pharmacologic side effects. In addition to the questionnaire, patients were interviewed prior to pump refills or dose adjustments. A physician not involved in device implantation
RESULTS
The pump implant database involved 122 patients. Twenty-five (n= 25) patients were excluded because of loss to follow-up/transfer of care to another area (n= 5), pump implanted at other facilities/operative data not available (n= 12) and pump implants prior to 1991 (database incomplete) (n= 8). Data on the excluded patients were reviewed separately. Ninety-seven patients from 1992 to 1999 were included in the study. There were 60 men and 37 women with age range of 28–85 years. Average follow up
DISCUSSION
Though a large number of small series regarding IDDS have been reported, there are only a few large studies describing the complications of intrathecal drug delivery systems (4,9., 10., 11.). We report one of the largest single implanter/facility series of complications associated with intrathecal drug delivery system implants. As more pumps are implanted, physicians have to become familiar with the potential complications associated with the procedure. The purpose of this study was to report a
CONCLUSION
IDDS is very effective for chronic pain management in appropriately selected patients. The complications associated with IDDS are mostly pharmacologic and transient. With equipment improvement, meticulous attention to the implant technique, and a better understanding of the intrathecal drugs, complications can be significantly reduced.
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Cited by (45)
Intrathecal Pumps
2022, Physical Medicine and Rehabilitation Clinics of North AmericaAdverse Events and Complications Associated With Intrathecal Drug Delivery Systems: Insights From the Manufacturer and User Facility Device Experience (MAUDE) Database
2021, NeuromodulationCitation Excerpt :The rate of surgical site infection in one reported study was 6.5% (12). Catheter disconnection, leakage, programming errors, and bacterial meningitis were the reported AE in another small study (4). Post dural puncture headache (PDPH) after IDDS implantation was noted in 23% of the patients, and most patients were treated with conservative therapy, blood or fibrin glue patch (13).
Intrathecal Therapeutics: Device Design, Access Methods, and Complication Mitigation
2018, NeuromodulationTitle: Quantifying the change of spasticity after intrathecal baclofen administration: A descriptive retrospective analysis
2018, Clinical Neurology and NeurosurgeryCitation Excerpt :In general, the range of post-implant complications varies greatly [29]. Regardless the complication, the rate reported in our cohort was lower than reported averages with minimal morbidity and no mortality, suggesting that there are likely multiple important factors in ensuring good outcomes for patients, which could include factors such as an experience and surgical technique [2,17,29–31]. There are several limitations in this study.
The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks
2017, NeuromodulationCitation Excerpt :Other standard-of-care IT agents, such as the local anesthetic bupivacaine, alpha-2 agonists, and the opioids hydromorphone and fentanyl are often used off-label (3). Intrathecal drug delivery may result in AEs related to administered agents; indeed, pharmacological complications may be the most common cause of AEs in IDD (14). Intrathecal delivery of opioids may be associated with a number of side effects.
On the dispersion of a drug delivered intrathecally in the spinal canal
2019, Journal of Fluid Mechanics