Name of the Procedure:

Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir

Summary

This procedure involves the surgical placement or replacement of a device that delivers medication directly to the space around the spinal cord (intrathecal) or the epidural space. The device includes a subcutaneous reservoir that stores the medication for continuous infusion.

Purpose

The procedure is designed to manage chronic pain or severe spasticity that cannot be adequately controlled with oral medications. The goal is to provide consistent and targeted delivery of medication, reducing pain and improving the patient's quality of life.

Indications

• Chronic pain resulting from cancer, neuropathy, or failed back surgery syndrome.
• Severe spasticity due to conditions like multiple sclerosis, cerebral palsy, or spinal cord injury.
• Patients who have not responded to oral medications or other less invasive treatments.

Preparation

• Patients may need to fast for a specified number of hours before the procedure.
• Medication adjustments, such as stopping certain blood thinners, may be required.
• Pre-procedure diagnostic tests, such as MRI or CT scans, might be necessary to assess the spinal anatomy.

Procedure Description

1. The patient is positioned and an antiseptic solution is applied to the surgical site.
2. Local anesthesia or general anesthesia is administered.
3. An incision is made to create a pocket for the subcutaneous reservoir, usually in the abdomen or back.
4. A catheter is inserted either into the intrathecal or epidural space and connected to the reservoir.
5. The reservoir is secured in the subcutaneous pocket.
6. The incision is closed with sutures or staples.
7. The device is tested to ensure it is functioning correctly.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or surgical center.

Personnel

• Surgeon specialized in pain management or neurosurgery
• Anesthesiologist
• Surgical nurses
• Support staff

Risks and Complications

• Infection at the incision site or in the spinal area
• Device malfunction or dislodgement
• Leakage of cerebrospinal fluid
• Bleeding or hematoma formation
• Nerve damage, leading to weakness or sensory changes
• Adverse reactions to anesthesia

Benefits

• Significant reduction in pain or spasticity
• Targeted drug delivery minimizes systemic side effects
• Improved quality of life
• Patients may notice benefits shortly after the procedure, although full efficacy might take several days or weeks.

Recovery

• Post-procedure monitoring in a recovery area
• Pain management with medications
• Instructions on wound care and activity restrictions (e.g., avoiding heavy lifting)
• Follow-up appointments to monitor device function and adjust medication dosages
• Full recovery typically occurs within a few weeks

Alternatives

• Oral or transdermal medications
• Spinal cord stimulation
• Physical therapy and rehabilitation
• Less invasive pain management techniques such as nerve blocks
• Each alternative has its own pros and cons, and their appropriateness varies depending on the patient's condition and response to previous treatments.

Patient Experience

• The patient might feel some discomfort at the incision sites.
• Pain at the surgical site can be managed with prescribed pain relievers.
• Regular follow-up is essential to adjust medication levels and ensure the device is functioning properly.
• Patients are advised to avoid strenuous activities during the initial recovery period to prevent complications.