Types
There are two type of intrathecal drug delivery system one is external infusion pump and other is implantable pump in our body.
Intrathecal implantable pump
A spinal infusion pump implant, commonly known as a morphine pump, is a specialized device, which delivers concentrated amounts of medication into the spinal fluid space via a small catheter. The intrathecal space is the sac that contains the spinal fluid. The spinal infusion pump is also known as an intrathecal infusion pump.
Indication
Spinal infusion pump implants are offered to patients with chronic and severe pain, who have not adequately responded to other treatment like medicine, physiotherapy or surgery. Following is some condition which might require an intrathecal pump,
- Post spine surgery pain
- Cancer related pain
- CRPS Type I & II
- Severe osteoporosis
- End-stage arthritis.
- Severe Neuropathic pain
Usually, these patients cannot be easily controlled on oral pain medications. Thus, to control their pain, these patients may benefit from a continuous spinal infusion of pain medication, usually morphine. Patients have to also meet certain other screening criteria before a spinal infusion pump is implanted.
Purpose of a spinal infusion pump
Dose of medication required for control of pain is significantly reduce in intrathecal drug delivery system.
The spinal infusion pump delivers concentrated amounts of medication into the spinal fluid, thus continuously bathing the pain receptors on the spinal cord with pain medication.
This allows the patient to eliminate or substantially decrease the need for oral medications for pain. It delivers medication round the clock, thus eliminating or minimizing breakthrough pain and other symptoms.
Procedure Details
- It is done with the patient lying on the side. Sometimes the tubing is placed with the patient in the prone position.
- The patients are monitored with EKG, blood pressure cuff and an oxygen-monitoring device.
- Most of the time this procedure done under local anaesthesia only.
- The skin is cleaned with antiseptic solution.
- Live x-ray is used to guide the introducer needle for inserting the infusion catheter.
- Once the catheter is in good position, a plastic anchor is used to attach the infusion catheter to the spinal ligaments. Then a tunnel is made from the back to the lower abdomen with a special tunnelling tool.
- A pocket under the skin is made in the lower abdomen into which the infusion pump will be placed.
- The pump is filled with morphine and the catheter is attached to the pump.
- Once this is done, the incision is closed with sutures and sterile dressing applied.
Post procedure advise
- This procedure is normally an outpatient procedure. Many patients go home several hours after the pump is inserted. Some patients are kept overnight for observation and pump adjustment.
- Antibiotic pills are given to decrease the risk of infection.
- The physician will check the wound in about three to five days. If the wound is dry, the dressings will probably be removed at that time.
- The stitches will be removed in about two weeks or so.
Complications
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. Bruising, soreness, swelling and other tenderness are very common. Headaches, tingling, short-term weakness or numbness caused by the catheter placement are much less common but do occur. Bleeding and infection are uncommon as are other serious complications.
FAQs
How long will the spinal infusion pump last?
The medication contained within the pump will last about 1 to 3 months depending upon the concentration and amount infused. It is then refilled via a tiny needle inserted into the pump chamber. This is done in the clinic or at your home and it takes only a few minutes. The batteries in the pump may last 3 to 5 years depending upon the usage and it may be variable in according to company supplies.
Can I have an MRI if I have a spinal infusion pump?
MRIs, if truly necessary, can be performed with a spinal infusion catheter and infusion pump in place. Special protocols for pump patients can be given to the MRI technicians and radiologists.
Can I pass through airport security with a spinal infusion pump?
Maybe. Depending on the sensitivity of the specific screening device, many patients can pass through with ease, just like some patients with pacemakers. If not, all patients are provided with identification indicating that a medical device has been implanted.