Name of the Procedure:

Continuous Epidural or Subarachnoid Drug Administration (Spinal Infusion Pump)

Summary

This procedure involves the daily management of a device that continuously delivers medication directly into the epidural or subarachnoid space in the spine. It is commonly used to manage chronic pain or severe spasticity by providing consistent and localized drug administration.

Purpose

The procedure addresses conditions involving chronic pain or severe muscle spasticity that are not adequately controlled by oral or systemic medications. The goal is to deliver medication directly to the spinal area, providing targeted pain relief and reducing side effects compared to systemic drug administration.

Indications

• Chronic pain conditions (e.g., cancer pain, post-operative pain, neuropathic pain)
• Severe spasticity (e.g., multiple sclerosis, spinal cord injury)
• Patients who have not responded adequately to oral medications
• Patients who experience significant side effects from oral/systemic medications

Preparation

• Patients may need to fast for several hours before implantation.
• Adjustments to current medications might be necessary.
• Pre-operative assessments may include imaging studies and lab tests.
• Psychological evaluation to ensure the patient can manage the device.

Procedure Description

1. Initial Placement (if not already done): A spinal catheter is inserted into the epidural or subarachnoid space during minor surgery.
2. Attachment: The catheter is connected to an infusion pump, which is either external or implanted under the skin.
3. Programming: The pump is programmed to deliver drugs at a constant rate.
4. Daily Management: Regular monitoring and maintenance of the infusion pump and catheter ensure proper function and adjust medication dosage as necessary.
5. Equipment Used: Infusion pump, spinal catheter, sterile dressing supplies.
6. Anesthesia: Local or general anesthesia for device implantation; local anesthesia for catheter maintenance if needed.

Duration

Daily management typically takes about 20-30 minutes. Initial implantation may take 1-2 hours.

Setting

The procedure is managed in a hospital or specialized pain management clinic.

Personnel

• Pain management specialists
• Anesthesiologists
• Nurses
• Interventional radiologists (for initial placement)

Risks and Complications

• Infection at the implantation site
• Catheter dislodgement or blockage
• Pump malfunction
• Medication side effects, such as nausea or sedation
• Rare: Cerebrospinal fluid leak or neurological complications

Benefits

• Targeted pain relief
• Reduced systemic side effects
• Improved quality of life
• Continual, consistent medication delivery

Recovery

• Post-implantation recovery includes wound care and limited activity for a few days.
• Patients might experience immediate pain relief but should follow up regularly to adjust dosages.
• Long-term management includes periodic visits for pump refills and adjustments.

Alternatives

• Oral or systemic medications
• Peripheral nerve blocks or other regional anesthesia techniques
• Physical therapy or other non-pharmacologic treatments
• Each alternative varies in effectiveness and side effects, and systemic options may have higher systemic side effects.

Patient Experience

• During management, patients may experience little to no discomfort; initial implantation involves mild to moderate pain.
• Post-procedure comfort measures include pain relievers for post-operative pain.
• Patients can expect ongoing support from their healthcare providers to manage medication dosages and address any concerns.