Intrathecal drug delivery systems complication
Background
- Used for delivery of short or long acting pain or anti-spasmodic medications into the thecal space
- Allows for smaller doses and fewer systemic side effects
- Most common Intrathecal medications
- Clonidine
- Bupivacaine
- Morphine
- Hydromorphone
- Fentanyl
- Baclofen
- Ziconotide
Differential Diagnosis
Complications:
- Overdose of medication, see:
- Opioid toxicity
- Clonidine toxicity
- Local anesthetic systemic toxicity
- Baclofen toxicity
- Respiratory depression is feared effect of most
- Infection
- Local cellulitis
- Meningitis
Management
- The device is not removed in an overdose but should be turned off.
- Insertion of a 22-guage needle into the pump reservoir can remove all medication in case device cannot be turned off
- Consider naloxone to reverse opioid effects taking into account patients chronicity of treatment if they withdrawal
- Treat infection aggressively with antibiotics
- May be treated without device removal with combination of IV and intrathecal antibiotics[1], but consult ID and/or anesthesia/appropriate surgical specialty as device may need to be removed
See Also
References
- Aristedis R, Dimitrios P, Nikolaos P, Alexandros B. Intrathecal baclofen pump infection treated by adjunct intrareservoir teicoplanin instillation. Surg Neurol Int. 2017;8:38.
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