Fibrin glue as a drug delivery system

A postdural puncture headache (PDPH) is a well-described complication after implantation of an intrathecal drug delivery system (IDDS). Treatment is typically with supportive management with the occasional need for an epidural blood patch. We describe a case of a patient with refractory muscle spasticity secondary to cerebral palsy that required a baclofen IDDS implantation and subsequently developed a PDPH. After failing conservative therapy as well as an epidural blood patch, the decision was made to attempt an epidural fibrin patch, which transiently improved her headache. Upon return of the patient’s symptoms, computed tomography myelogram demonstrated an extensive cerebrospinal fluid leak with ventral spread into the retroperitoneal space. Using a novel technique, a second epidural fibrin glue patch was administered just adjacent to the IDDS catheter insertion point, which was then successful in resolving her symptoms. Key words: Intrathecal drug delivery system, postdural puncture headache, dural tear, cerebrospinal fluid (CSF) leak, fibrin glue, epidural blood patch

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Fibrin glue as a local drug-delivery system for bacteriophage PA5

Scientific Reports ◽

10.1038/s41598-018-38318-4 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 13

Author(s):

Evgenii Rubalskii ◽

Stefan Ruemke ◽

Christina Salmoukas ◽

Andrey Aleshkin ◽

Svetlana Bochkareva ◽

...

Keyword(s):

Drug Delivery ◽

Drug Delivery System ◽

Fibrin Glue ◽

Delivery System ◽

Local Drug Delivery ◽

Local Drug Delivery System

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Post Dural Puncture Headache Following Intrathecal Drug Delivery System Placement

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/101 ◽

2013 ◽

Vol 2;16 (2;3) ◽

pp. 101-107 ◽

Cited By ~ 1

Author(s):

Dr. Stephanie A. Neuman

Keyword(s):

Drug Delivery ◽

Drug Delivery System ◽

Fibrin Glue ◽

Delivery System ◽

Dural Puncture ◽

Surgical Techniques ◽

Key Words Pain ◽

Post Dural Puncture Headache ◽

Intrathecal Drug Delivery ◽

Blood Patch

Background: Placement of an intrathecal drug delivery system (IDDS) may provide substantial benefit to certain patients. However, placement of these devices is not without complications, and minimal data exist describing the rates of these complications. Specifically, there is a paucity of data describing the incidence of post dural puncture headache (PDPH) following IDDS placement. Objectives: The aim of this study was to identify the incidence and treatment course of PDPH following placement of an IDDS in a retrospective review. Study Design: Retrospective assessment of medical records. Setting: Department of Pain Medicine and Anesthesiology, Mayo Clinic, Rochester, MN. Methods: Following IRB approval, 319 IDDS surgical reports in 285 patients were identified retrospectively over a 20 year study time period. We report demographic information, number of dural punctures, techniques for sealing dural leak, details, and treatment course of PDPH in this population. Results: Symptoms of PDPH were recognized in 73 individual cases (23% of total procedural volume). Younger patient age was the only statistically significant characteristic in predicting development of a PDPH. There were no statistically significant differences found in regards to other risk factors for PDPH development or treatment strategy employed. Seventy-nine percent of PDPH patients were successfully managed with conservative non-interventional therapies (bedrest, IV fluids, analgesics, antiemetics), while 21% required progression to epidural blood or fibrin glue patch procedures for full resolution of symptoms. Limitations: Limitations include the retrospective design of the study as well as the potential for undocumented or improperly documented surgical techniques and/or events. Conclusion: Though the development of PDPH after IDDS implantation was found to be fairly common (23% incidence), the majority of these patients had self-limited symptoms that resolved with conservative medical management. Epidural blood patch or application of epidural fibrin glue was therapeutically successful for the remainder of PDPH patients who were refractory to conservative measures. Key words: Pain, intrathecal drug delivery system, pain pump, morphine, baclofen, postdural puncture headache, spinal headache

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Preventing Post Dural Puncture Headache after Intrathecal Drug Delivery System Implantation Through Preventive Fibrin Glue Application: A Retrospective Study

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e211-e220 ◽

2021 ◽

pp. E211-E220

Keyword(s):

Drug Delivery ◽

Drug Delivery System ◽

Fibrin Glue ◽

Delivery System ◽

Dural Puncture ◽

Univariate Analysis ◽

Duration Of Symptoms ◽

Post Dural Puncture Headache ◽

Intrathecal Drug Delivery ◽

Csf Leakage

BACKGROUND: Cerebrospinal fluid (CSF) leakage resulting in post dural puncture headache (PDPH) is a frequent adverse effect observed after intrathecal drug delivery system (IDDS) implantation. CSF leakage symptoms negatively affect patient quality of life and can result in additional complications. Fibrin glue was used to treat CSF leakage syndrome. We developed a procedure to reduce the incidence of PDPH by preventing CSF leakage with the use of fibrin glue during surgery. OBJECTIVES: The main outcome criterion for this study was the incidence of PDPH syndrome after IDDS implantation with or without preventive fibrin glue application during the procedure. STUDY DESIGN: We designed a monocentric retrospective cohort study to compare the incidence of PDPH due to CSF leakage syndrome after lumbar puncture in patients with an implanted intrathecal pump, with or without preventive fibrin glue application during the procedure. SETTING: The study was held in the Anesthesiology and Pain department of the Integrative Cancer Institute (ICO), Angers - France. METHODS: The study compared 2 patient cohorts over 2 successive periods. Fibrin glue was injected into the introducer needle puncture pathway after placement of the catheter immediately following needle removal. RESULTS: The no-glue group included 107 patients, whereas the glue group included 92 patients.Two application failures were observed (2.04%). Fibrin glue application results in a significant decrease in PDPH incidence, from 32.7% in the no-glue group to 10.92 % (P < 0.001) in the glue group. In regard to severity, in the no-glue group, 37.1% of PDPH syndromes were mild, 34.3% were moderate, and 28.6% were severe. In the fibrin glue group, 80% of PDPH syndromes were mild, and 20% were moderate. No severe PDPHs were reported after fibrin glue application. Duration of symptoms was also statistically shorter in the fibrin glue group (maximum of 3 days vs. 15 days in the no-glue group). In a univariate analysis, preventive fibrin glue application and age are significant to prevent PDPH. In multivariate analysis, only fibrin glue application was statistically significant (odds ratio, 0.26; P = 0.0008). No adverse effects linked to fibrin glue were observed. LIMITATIONS: The main limitation of this study is its retrospective nature. In addition, this study is from a single center with a potential selection bias and a center effect. CONCLUSIONS: The novel use of fibrin glue is promising in terms of its effect on PDPH and its safety profile. Its moderate cost and reproducibility make it an affordable and efficient technique. KEY WORDS: Fibrin glue post dural puncture headache, intrathecal therapy, surgical outcome, cancer pain, palliative care, hospice

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