Name of the Procedure:

Infusion Pump System, Implantable, Programmable

• Common Name: Implantable Infusion Pump
• Technical/Medical Term: Programmable Implantable Infusion Pump System (HCPCS Code: E0783)

Summary

An implantable infusion pump is a small, programmable device that is surgically placed inside the body to deliver medication directly to a specific area, such as the spinal cord. The system includes a pump, catheter, and necessary connectors.

Purpose

Implantable infusion pumps are used to manage chronic pain or severe muscle spasticity that cannot be controlled by oral medications. The primary goal is to deliver medication in precise doses directly to the target area to alleviate symptoms more effectively and reduce systemic side effects.

Indications

• Chronic pain due to conditions like cancer, failed back surgery syndrome, or reflex sympathetic dystrophy.
• Severe muscle spasticity such as that caused by spinal cord injury, multiple sclerosis, or cerebral palsy.
• Patients who have not responded to more conservative treatment options or have experienced intolerable side effects from oral medications.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustments to current medications as instructed by the healthcare provider.
• Preoperative assessments including blood tests, imaging studies, and possibly a trial infusion to determine efficacy.

Procedure Description

1. Anesthesia: The patient is placed under general or regional anesthesia.
2. Incision: A small incision is made in the abdomen to create a pocket for the pump, and another incision near the spine for catheter placement.
3. Placement: The catheter is inserted and tunneled to the targeted area, while the pump is positioned within the abdominal pocket.
4. Connection: The catheter is connected to the pump, and the pump is programmed to deliver the medication at controlled rates.
5. Closure: Incisions are closed with sutures, and the patient is monitored during the initial recovery.

Duration

The procedure typically takes around 2 to 3 hours.

Setting

Usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeons (neurosurgeons or pain management specialists)
• Anesthesiologists
• Surgical nurses
• Technicians for programming the pump

Risks and Complications

• Infection at the surgical site
• Cerebrospinal fluid leak
• Catheter dislodgement or blockage
• Pump malfunction or failure
• Allergic reaction to the medication
• Complications from anesthesia

Benefits

• Enhanced pain relief with lower doses of medication.
• Reduced systemic side effects compared to oral medications.
• Improvement in quality of life and daily functioning.
• Benefits can often be observed within days to weeks after the procedure.

Recovery

• The patient may need to stay overnight in the hospital.
• Pain management will be crucial in the immediate postoperative period.
• Instructions will include wound care, activity restrictions, and follow-up visits for pump adjustments.
• Full recovery typically takes 2 to 4 weeks.

Alternatives

• Oral or transdermal medications.
• Non-surgical pain management techniques, including physical therapy, nerve blocks, or nerve stimulators.
• Pros: Less invasive, no surgical risks.
• Cons: Often less effective for refractory cases, higher systemic side effects.

Patient Experience

• During the procedure: Asleep or sedated due to anesthesia.
• After the procedure: Postoperative pain managed with medication. Soreness at the incision sites. Gradual ramp-up of daily activities as tolerated.
• Long-term: Regular follow-up appointments for pump refill and dose adjustments. Improved symptom management and overall comfort.