Name of the Procedure:

Implantation or Replacement of Device for Intrathecal or Epidural Drug Infusion; Programmable Pump

Summary

This procedure involves surgically placing or replacing a programmable pump designed to deliver medication directly to the intrathecal or epidural space around the spinal cord. By doing so, it allows for controlled drug infusion to manage chronic pain or spasticity.

Purpose

This procedure addresses chronic pain and severe spasticity that does not respond well to oral medications or other forms of therapy. The goal is to provide continuous, localized pain relief or muscle relaxation while minimizing systemic side effects.

Indications

• Chronic pain due to cancer, nerve damage, or other conditions
• Severe spasticity related to multiple sclerosis, spinal cord injury, or cerebral palsy
• Patients unresponsive to conventional treatments
• Need for continuous medication delivery with dosage control

Preparation

• Patients may need to fast for 8 hours before the procedure.
• Necessary adjustments to existing medication need to be discussed with your doctor.
• Pre-procedure diagnostic tests may include blood work and imaging studies, like MRI or CT scans, to plan the pump placement.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Insertion: A small incision is made, usually in the abdomen or back, to create a pocket for the pump.
3. Catheter Placement: A catheter is threaded from the pump to the intrathecal or epidural space.
4. Pump Connection: The pump is connected to the catheter.
5. Testing and Programming: The pump is prepared, filled with medication, and programmed to deliver specific doses at set intervals.
6. Closure: Incisions are closed with sutures.

Duration

The procedure typically takes 1-2 hours.

Setting

Performed in a hospital or specialized surgical center.

Personnel

• Surgeons
• Anesthesiologists
• Nurses
• Surgical technicians

Risks and Complications

• Infection
• Bleeding
• Device malfunction
• Catheter displacement
• Allergic reaction to anesthesia
• Potential for requiring a second surgery to correct any issues

Benefits

• Effective long-term pain relief or muscle spasm control
• Reduced need for oral pain medications
• Minimized systemic side effects
• Improved quality of life

Recovery

• Initial hospital stay of 1-2 days for monitoring
• Follow-up appointments for pump adjustments and refills
• Avoid heavy lifting and strenuous activity for a few weeks
• Pain and tenderness at the incision sites, managed with prescribed medications

Alternatives

• Oral or topical medications
• Other forms of pain management such as nerve blocks
• Physical therapy
• Chiropractic care
• Alternative therapies like acupuncture
• Pros and cons involve less invasiveness but potentially less effective and more systemic side effects.

Patient Experience

• Discomfort at the incision sites post-surgery
• Relief from pain or spasticity within days to weeks
• Regular follow-ups for medication refill and pump management
• Effective pain relief and improved functionality, leading to enhanced daily living activities