Intrathecal Drug Delivery Systems

2018 ◽  
Author(s):  
Deepti Agarwal ◽  
Ifeyinwa C. Ifeanyi ◽  
Mercy A. Udoji
Keyword(s):  
Drug Delivery ◽  
Hypogonadotropic Hypogonadism ◽  
Csf Leak ◽  
Intrathecal Therapy ◽  
Drug Delivery Device ◽  
Intrathecal Drug Delivery ◽  
Nonmalignant Pain ◽  
Surgical Bleeding ◽  
Chronic Nonmalignant Pain ◽  
Maximal Medical Therapy

Intrathecal drug delivery (ITDD), while initially intended for terminal oncology patients suffering from cancer pain, is currently widely used for chronic nonmalignant pain states. Before intrathecal drug delivery device (IDDD) implantation, patients with nonmalignant chronic pain must be screened for psychologic, behavioral, and medical etiologies for their pain, in addition to having a documented failure of maximal medical therapy and a successful intrathecal drug trial. Classes of drugs used for intrathecal therapy include opioids, local anesthetics, adrenergic agonists, and NMDA receptor agonists. Drugs currently approved by the FDA for ITDD are morphine, ziconotide, and baclofen. Complications of IDDD implantation are surgical (bleeding, infection, CSF leak, nerve injury), mechanical (due to catheter kink, shear, or disconnection), pharmacologic (overdose, incorrect pump settings, contaminated drugs), or medical (hypogonadotropic hypogonadism).

scholarly journals Androgen Deficiency in Long-Term Intrathecal Opioid Administration

2014 ◽  
Vol 4;17 (4;7) ◽  
pp. E543-E548
Author(s):  
Chong H. Kim
Keyword(s):  
Drug Delivery ◽  
Case Series ◽  
Androgen Deficiency ◽  
Endocrine Dysfunction ◽  
Intrathecal Drug Delivery ◽  
Opioid Administration ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
Intrathecal Opioid Administration

Background: Intrathecal drug delivery of opioids is an efficient and effective treatment option for pain management in the chronic nonmalignant pain population. As with all treatments, in addition to the benefits, risks and side effects exist. One such risk in intrathecal opioids is opioid-induced androgen deficiency. Objective: This study evaluates opioid-induced androgen deficiency in long-term intrathecal opioid administration in chronic nonmalignant pain. Study Design: Case series. Sixteen consecutive patients with intrathecal drug delivery with opioids were screened for androgen deficiency. Setting: Academic university-based pain management center. Method: All the subjects were seen in a 2 month period, during a scheduled maintenance refill visit. Eight consecutive men and eight consecutive women receiving intrathecal drug delivery therapy for non-malignant chronic pain were ordered blood work and asked to complete a questionnaire. Patient and patient-related data were also collected. Results: Ten of the 16 (62.5%) patients were found to have androgen deficiency, 4 of 8 men based on free testosterone levels and 6 of 8 women based on DHEA levels. In men, erectile dysfunction correlated with endocrine dysfunction (P = 0.02) while depressive symptoms correlated in women (P = .03). Overall, 2 of the 16 patients had hydromorphone as the opioid in the intrathecal system. Both patients had normal endocrine functions. Both patients with hydromorphone were men and the use of hydromorphone showed an insignificant trend (P = 0.06). Three of the 4 men with normal endocrine functions had in addition to an opioid, bupivacaine, in the intrathecal system. The presence of bupivicaine in men was significant (P = 0.02). No women had bupivicaine while one of the 8 women had clonidine in addition to the opioid. Presence of another substance in addition to the opioid showed an insignificant trend (P = 0.08). Limitations: Study limitations include the small sample size and case series nature. Additionally the symptoms data was solely based on subjective patient reports. Conclusions: Androgen deficiency is common in patients treated with intrathecal opioids for chronic nonmalignant pain. Patients experience numerous and wide ranging symptoms. Erectile dysfunction may be more suggestive for androgen deficiency in men while complaints of depressed mood may be correlative in women. Additionally, combining bupivicaine with the intrathecal opioid may provide a protective role. Key words: Androgen deficiency, endocrine dysfunction, chronic nonmalignant pain, intrathecal opioid, intrathecal drug delivery, side effects

Multiple Fibrin Glue Use in a Complicated Case of Postdural Puncture Headache Following Intrathecal Drug Delivery System Placement: A Case Report

2019 ◽  
pp. 77-81
Author(s):  
Matthew Chung
Keyword(s):  
Drug Delivery ◽  
Cerebrospinal Fluid ◽  
Drug Delivery System ◽  
Fibrin Glue ◽  
Delivery System ◽  
Epidural Blood Patch ◽  
Csf Leak ◽  
Postdural Puncture Headache ◽  
Intrathecal Drug Delivery ◽  
Blood Patch

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

Bilateral Subdural Hematoma Following Implantation of Intrathecal Drug Delivery Device

2011 ◽  
Vol 14 (2) ◽  
pp. 179-182 ◽  
Author(s):  
Elsa Magro ◽  
Olivier Remy-Neris ◽  
Romuald Seizeur ◽  
Vincent Allano ◽  
Bertrand Quinio ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Subdural Hematoma ◽  
Delivery Device ◽  
Drug Delivery Device ◽  
Intrathecal Drug Delivery

scholarly journals Cerebrospinal Fluid Leak Presenting with Radiculitis and Delayed Onset Headache Following Intrathecal Pump Implantation

2017 ◽  
pp. 89-92
Author(s):  
Laura Anne Lynem
Keyword(s):  
Drug Delivery ◽  
Drug Delivery System ◽  
Delivery System ◽  
Dural Puncture ◽  
Fluid Collection ◽  
Laboratory Evaluation ◽  
Csf Leak ◽  
Access Port ◽  
Lower Back ◽  
Intrathecal Drug Delivery

The issue of cerebrospinal fluid (CSF) leak due to catheter-related failure persists despite new approaches to surgical techniques. There is limited literature about atypical presentations of post dural puncture headaches post intrathecal drug delivery system (IDDS) implantation. A 59-year-old woman with a past medical history of lumbar postlaminectomy syndrome, chronic pain, and lower back pain underwent an intrathecal drug delivery system implantation after exhausting other modalities for pain relief. The patient presented to the office one-month postoperatively with symptoms of lower back pain, left lower extremity radiculopathy, and lower back subcutaneous fluid collection. A dye study using catheter access port access revealed a patent intrathecal catheter with no fluid leakage or collection after injecting contrast dye through the catheter access port. A fine needle aspiration performed under ultrasound guidance revealed a clear fluid. Using laboratory evaluation, this was confirmed to be CSF using laboratory evaluation. An epidural blood patch was performed, which provided minimal radicular pain relief. Several days after, she began experiencing fronto-occipital headaches and the lumbar fluid collection reaccumulated. An intrathecal dye study again was done and showed retrograde flow from the catheter causing a lumbar fluid collection. A catheter exchange was performed resolving the CSF leak and the patient’s symptoms. Post dural puncture headaches after IDDS implantation may have an atypical presentation. Providers should ensure the intrathecal catheter is well secured and firmly anchored to prevent migration. Patient symptoms after IDDS implantation may necessitate further investigation, including: patient evaluation, confirming catheter continuity, and minimally invasive or surgical management. Complications from IDDS may be reduced with further research on equipment and implantation techniques. Key words: Intrathecal drug delivery system, neuraxial analgesia, chronic pain, post dural puncture headache, post laminectomy syndrome, intrathecal catheters

Sudden Intrathecal Drug Delivery Device Motor Stalls

2018 ◽  
Vol 43 (6) ◽  
pp. 654-655 ◽  
Author(s):  
Matthew T. McEwan ◽  
Salim M. Hayek ◽  
Ryan Galica ◽  
Vidya Sundaram ◽  
Elias Veizi
Keyword(s):  
Drug Delivery ◽  
Delivery Device ◽  
Drug Delivery Device ◽  
Intrathecal Drug Delivery

scholarly journals Consensus Guidelines for the Selection and Implantation of Patients With Noncancer Pain for Intrathecal Drug Delivery

2010 ◽  
Vol 3;13 (3;5) ◽  
pp. E175-E213 ◽  
Author(s):  
Timothy R. Deer
Keyword(s):  
Drug Delivery ◽  
Evaluation Process ◽  
Psychological Status ◽  
Social Characteristics ◽  
Intrathecal Therapy ◽  
Intractable Pain ◽  
Consensus Guidelines ◽  
Intrathecal Drug Delivery ◽  
Proper Patient Selection ◽  
Noncancer Pain

Intrathecal therapy offers an invasive alternative for the long-term management of select patients with intractable pain associated with various disease states, including those of noncancer origin. It is commonly accepted that proper patient selection is essential to optimizing treatment outcomes, yet the practice of candidate selection for device implantation varies widely. A multifaceted approach—with consideration of preexisting medical comorbidities; psychological status; associated social, technical, and economic issues; and response to intrathecal trialing—enables practitioners to fully evaluate the appropriateness of implanting a patient with an intrathecal drug delivery system. Yet, to date no standard set of guidelines have been developed to aid practitioners in navigating this evaluation process. Using experience- and knowledge-based expert opinion to systematically evaluate the available evidence, this article provides consensus guidelines aimed at optimizing the selection of patients with noncancer pain for intrathecal therapy. In conclusion, complete assessment of a patient’s physical, psychological, and social characteristics, can guide practitioners in determining the appropriateness of initiating intrathecal therapy. These consensus guidelines are intended to assist with weighing this risk/benefit ratio of intrathecal therapy, thereby minimizing the potential for treatment failure, unacceptable adverse effects, and excess mortality. Key words: Chronic pain, noncancer pain, opioids, intrathecal drug delivery systems, guidelines, consensus guidelines

Complications associated with intrathecal drug delivery in a paediatric patient with Niemann-Pick type C

2021 ◽  
Vol 14 (5) ◽  
pp. e241786
Author(s):  
Jose Ignacio Rodriguez Rodriguez Ciancio ◽  
Kristian Aquilina
Keyword(s):  
Drug Delivery ◽  
Medicinal Product ◽  
Significant Risk ◽  
Neurological Injury ◽  
Drug Delivery Device ◽  
Intrathecal Drug Delivery ◽  
Type C ◽  
Niemann Pick ◽  
Intrathecal Space

We report on a male subject with a diagnosis of Niemann-Pick type C (NPC). He received an experimental medicinal product intrathecally initially via lumbar puncture (LP) and eventually via intrathecal drug delivery device. Shortly after implantation, the device catheter migrated outside of the intrathecal space and coiled subcutaneously. The treatment continued via LP after removal of the device. A subdural haematoma developed after repeated LPs. It was surgically evacuated and the patient recovered with sequelae. Surgically implanted drug delivery devices are designed to bypass the blood–brain barrier and deliver a medicinal product directly into the cerebrospinal fluid circulation. Their use has extended into the field of neurodegenerative disorders. Significant adverse events can occur at any given time after implantation including neurological injury, dislodgement or displacement of any of its components, infection and drug-related complications; all can significantly affect the quality of life of patients. Repeated LPs also carry significant risk.

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