Name of the Procedure:

Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump

Summary

This procedure involves surgically implanting or replacing a nonprogrammable pump that delivers medication directly into the spinal fluid or the epidural space to manage chronic pain or spasticity.

Purpose

• Medical Condition: Chronic pain, spasticity, or severe muscle stiffness.
• Goals: To provide effective pain relief, improve quality of life, and minimize side effects by delivering medication directly to targeted areas.

Indications

• Conditions: Chronic pain unresponsive to oral medications, spasticity from conditions like multiple sclerosis or spinal cord injury.
• Patient Criteria: Patients who require long-term pain management or spasticity control, and who have not found relief from other treatments.

Preparation

• Instructions: Patients may be advised to fast for several hours before the procedure and stop certain medications as instructed by their doctor.
• Diagnostic Tests: Pre-operative imaging tests (e.g., MRI or CT scan) and evaluations to determine the suitability for the pump.

Procedure Description

1. Anesthesia: General or local anesthesia is administered.
2. Incision: A small incision is made in the abdomen or flank.
3. Placement: The nonprogrammable pump is placed subcutaneously (under the skin), typically in the lower abdomen.
4. Catheter Insertion: A catheter is threaded from the pump to the intrathecal or epidural space in the spine.
5. Connection: The catheter is connected to the pump.
6. Closure: Incisions are closed with sutures or staples.
7. Testing: The system is tested to ensure correct medication delivery.

Tools used: Surgical instruments, nonprogrammable pump, catheter system.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Usually performed in a hospital operating room.

Personnel

• Surgeons.
• Anesthesiologists.
• Nurses and surgical technicians.

Risks and Complications

• Common Risks: Infection, bleeding, pump malfunction or failure.
• Rare Risks: Nerve damage, cerebrospinal fluid leak, respiratory issues.
• Management: Most complications can be managed with medical intervention or additional procedures.

Benefits

• Effective relief from chronic pain or spasticity.
• Reduced reliance on oral medications.
• Improved quality of life.
• Benefits can be noticed a few days to weeks post-procedure.

Recovery

• Post-Procedure Care: Pain management, wound care, and activity restrictions.
• Instructions: Avoid heavy lifting, follow a physiotherapy plan if recommended.
• Recovery Time: Initial recovery within 1-2 weeks with full recovery in about 6 weeks.
• Follow-up: Regular check-ups to monitor pump function and refill medication.

Alternatives

• Other Options: Oral or injectable medications, physical therapy, nerve blocks, spinal cord stimulators.
• Comparison: Alternatives may not offer targeted relief and could have more systemic side effects.

Patient Experience

• During the Procedure: Patients are under anesthesia, so they should not feel pain.
• After Procedure: Mild to moderate post-operative discomfort managed with prescribed pain medication.
• Pain Management: Gradual adaptation to medication release from the pump, with adjustments as needed for comfort.