II. Mechanism

  1. Intrathecal drug delivery for maximal pain relief with less adverse effects
    1. Avoids the Sedation of antispasmodics such as Baclofen
    2. Avoids the Nausea, Pruritus and Sedation of systemic Opioids
  2. Catheter inserted into intrathecal space cerebrospinal fluid
    1. Catheter tunneled around Abdomen and into the lower abdominal wall
    2. Insertion by interventional pain management specialists or Neurosurgeons
  3. Pump refills
    1. Pump port is accessed via needle through the skin

III. Preparations

  1. FDA approved agents to be used in Intrathecal Pumps
    1. Morphine
    2. Baclofen
    3. Ziconotide
  2. Off-Label medication uses within Intrathecal Pumps
    1. Hydromorphone
    2. Bupivicaine
    3. Fentanyl
    4. Clonidine

IV. Complications

  1. Clonidine Pump malfunction with Drug Withdrawal
    1. Clonide withdrawal results in hypertensive emergencies
  2. Baclofen Pump Malfunction with Drug Withdrawal
    1. Baclofen withdrawal results in hemodynamic instability, Seizures
    2. May present with signs similar to Sepsis
      1. May present with Tachycardia, Tachypnea, fever and confusion (all consistent with Sepsis)
      2. However, in contrast with Sepsis, Baclofen withdrawal presents with Hypertension
    3. Management
      1. Baclofen cannot be effectively replaced intravenously (needs intrathecal delivery)
      2. Inject Baclofen into the pump's side port OR via intrathecal space via spinal needle
        1. Typically performed by neurosurgery
      3. Other measures
        1. Benzodiazepines
        2. Propofol infusion may also counter withdrawal effects
          1. Initiate early before significant withdrawal, hemodynamic instability
    4. References
      1. Orman and Swaminathan in Herbert (2017) EM:Rap 17(1): 1
  3. Overdose
    1. Less common
    2. May occur on attempted pump port refill, if the port site is missed
  4. Infection
    1. May occur immediately after implantation, however otherwise infections are uncommon
  5. Catheter granuloma
    1. May result in local mass effect with pressure on spinal cord and risk of injury

V. Precautions

  1. Lumbar Puncture
    1. Interventionist may access side port of pump to withdraw CSF for analysis
    2. Do not perform blindly without identifying the course of the catheter
      1. XRay catheter region to determine involved levels
      2. Perform Lumbar Puncture under fluoroscopy if performing Lumbar Puncture in region of catheter
  2. MRI with implanted pump
    1. Consult specific pump guide or device consultant
    2. Precautions vary by pump
    3. Some pumps require medication to be withdrawn from reservoir before MRI due to risk of rapid infusion
  3. Anticoagulants and Thrombolytics
    1. Risk of intrathecal hematoma in perioperative period (insertion or removal)
    2. Anticoagulants and Thrombolytics should be avoided in the first 48 hours of catheter procedure
  4. Pump interrogation (e.g. flow rate settings)
    1. May be performed by device consultants as well as some hospital pharmacists

VI. References

  1. Lin, Coralic and Poree in Herbert (2015) EM:Rap 15(11):4-5

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Intrathecal pump insertion (C2363953)

Concepts Therapeutic or Preventive Procedure (T061)
English Intrathecal pump insertion
Spanish Inserción de bomba de infusión intratecal
Dutch intrathecale pomp plaatsing
Italian Inserzione di pompa intratecale
German Anlage einer Pumpe im Intrathekalraum
French Insertion de pompe intrathécale
Portuguese Inserção intratecal por bomba
Czech Intratekální zavedení pumpy
Japanese ズイクウナイポンプソウニュウ, 髄腔内ポンプ挿入
Hungarian Intrathecalis pumpa behelyezés

Ontology: Infusion Pumps, Analgesic, Implantable, Intrathecal (C3504070)

Definition (UMD) Analgesic infusion pumps intended for implantation that are designed for use in the administration of analgesics into the spinal fluid space (i.e., intrathecal). These pumps are frequently battery-powered devices. They are comprised of a syringe-driven mechanism that is inserted between the skin and the muscle of the lower abdomen; an infusion rate controller; and an internal reservoir containing the analgesic solution. The analgesic solution is delivered from the pump to a subcutaneous tube and then to a catheter with a needle at the distal end that is typically inserted in the intrathecal space. Intrathecal implantable pumps that deliver the analgesic without the use of batteries are also available; they are based on a two-chamber pump with an inner chamber containing the analgesic drug and an outer chamber containing a propellant. The temperature of the patient warms the propellant which in turn exerts a constant pressure on accordion-like bellows that divide both chambers. The pump must be also able to deliver a continuous or intermittent flow and/or deliver bolus doses of analgesics when necessary. Intrathecal analgesic infusion pumps are used mainly by patients with otherwise intractable chronic pain. These pumps may be used also to administer drugs (e.g., baclofen) for refractory spasticity.
Concepts Medical Device (T074)
English Analgesic Infusion Pumps, Implantable, Intrathecal, Infusion Pumps, Analgesic, Implantable, Intrathecal, Intrathecal Analgesic Infusion Pumps

Ontology: Baclofen Infusion Implantable Pumps (C3504191)

Concepts Medical Device (T074)
English Baclofen Infusion Implantable Pumps