Shivam
Pain Management
Centre
Help Line - 079-26301986, 26308976
     
     
 

Intrathecal Pump

 

INDICATION

Failed Back Surgery

Cancer pain

Spasticity

procedure

·         Prior to implantation patients undergo an intrathecal (IT) drug trial in the pain clinic, to help assess their suitability for the technique.

·         The most commonly used system is the totally implanted, battery operated pump. The pump head, which is about the size of the palm of your hand , is inserted underneath the skin, in the front part of the abdomen just under the ribs . A small catheter is then tunnelled around to the back under the skin to enter the spine and spinal fluid. Preservative-free drug is stored in the pump reservoir , and is delivered to the spine continuously in small increments. The total daily dose delivered is controlled by sensitive electronics in the pump head , and these settings can be altered by communicating with the pump using a remote control device.

Pump Refills

  • Before refilling can start, the pump is switched off, and the electronic record of the volume of IT solution remaining in the reservoir is noted. 
  • The old solution is removed and discarded. The pump head is accessed by placing a clean needle through sterilized skin, into the filling port in the centre of the pump. The filling port is located by using a specially designed shape template placed on the skin overlying the pump head.
  • The volume removed from the pump is then compared with the electronic record, so that the accuracy of the infusion can be checked.
  • The filling port is made of specially designed material so that it reseals after the refill needle is removed. The refill needle is designed so that it is non-cutting to avoid damage to the port. Ordinary hypodermic needles should NOT be used.
  • The pump head programme is checked for errors,  then the pump is switched back on again.

Complications

   immediate

  • IT Catheter Problems - The temporary catheter can occasionally fall out or snap despite adequate fixation.
  • Post Dural Puncture (Spinal) Headache -..
  • Infection
  • Drug Side Effects

 Drowsiness, dizziness, nausea and vomiting may occur during IT morphine titration

Respiratory depression.

Morphine withdrawal reactions.

Urinary retention and hesitancy.

Late  Complications

  • Infection.
  • Tolerance to IT morphine with gradual increase in dose requirements.
  • Low battery - sooner or later, between 3 - 6 years, the pump head battery will fail and need to be surgically replaced.

 

  • Pump Malfunction - very rarely the pump head electronics fail. Usually this causes the pump to stop, causing sudden onset pain and morphine withdrawal symptoms.