Name of the Procedure:

Infusion Pump, Programmable (Implantable)
Common name(s): Programmable infusion pump, Medtronic pump
Technical terms: Implantable drug delivery system, Intrathecal pump

Summary

A programmable infusion pump is a small device surgically placed under the skin to deliver medication directly to the fluid surrounding the spinal cord. It can be adjusted to control the dosage and timing of medication for managing chronic pain or muscle spasticity.

Purpose

The infusion pump is used to manage severe chronic pain and muscle spasticity that doesn't respond to oral medications. Its goal is to improve patients' quality of life by providing targeted and controlled medication delivery, often reducing side effects compared to oral medication.

Indications

• Chronic pain from conditions such as cancer, failed back surgery syndrome, or neuropathy
• Severe spasticity from multiple sclerosis, cerebral palsy, spinal cord injury, or stroke
• Patients for whom other treatments have been ineffective or caused intolerable side effects

Preparation

• Patients may be asked to fast for 6-8 hours before the procedure.
• Pre-procedure evaluations often include imaging studies like MRI or CT scans.
• Patients may need to adjust current medications under medical guidance.
• Labs and other diagnostic tests may be required to ensure proper candidacy for the procedure.

Procedure Description

1. Anesthesia: The procedure is typically performed under general or regional anesthesia.
2. Placement: A small incision is made in the abdomen to create a pocket for the pump. Another incision is made to insert a catheter into the intrathecal space around the spinal cord.
3. Connection: The catheter is connected to the pump, which is then placed in the pocket created in the abdomen.
4. Programming: The pump is programmed to deliver the specific dosage and timing of medication.
5. Closure: The incisions are closed with sutures or staples.

Duration

The procedure generally takes 1 to 2 hours.

Setting

Typically performed in a hospital operating room or specialized surgical center.

Personnel

• Surgeon (neurosurgeon or pain specialist)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Catheter dislodgement or blockage
• Pump malfunction
• Spinal fluid leaks
• Adverse reactions to anesthesia
• Overdose or underdose of medication

Benefits

• Targeted pain and spasticity relief
• Reduced systemic side effects compared to oral medications
• Improved quality of life and daily functioning
• Customizable medication delivery settings

Recovery

• Recovery typically involves a hospital stay of 1-2 days.
• Pain at the incision sites can be managed with prescribed pain medications.
• Patients may need to avoid strenuous activities for 4-6 weeks.
• Follow-up appointments are necessary to monitor function and adjust the pump settings.

Alternatives

• Oral or injectable medications
• Nerve blocks or epidural injections
• Physical therapy
• Spinal cord stimulators
• Intrathecal bolus injections (non-implantable)

Pros and cons: Oral medications might be less invasive but often come with systemic side effects. Nerve blocks and physical therapies may not provide long-lasting relief. Spinal cord stimulators and bolus injections have different indications and efficacy profiles.

Patient Experience

• Mild to moderate pain and discomfort from the incision sites post-procedure
• Relief of pain or spasticity may be noticed soon after the pump starts functioning
• Regular follow-ups ensure appropriate medication dosing and pump maintenance
• Pain management strategies and comfort measures (e.g., pillows, hot/cold packs) will be advised by healthcare providers.