Intrathecal drug delivery system complications: Difference between revisions
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==Background== | ==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]] | |||
==Clinical Features== | ==Clinical Features== | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Complications: | |||
*Overdose of medication, see: | |||
**[[Opioid toxicity]] | |||
**[[Clonidine toxicity]] | |||
**[[Local anesthetic systemic toxicity]] | |||
**[[Baclofen toxicity]] | |||
**[[Respiratory failure|Respiratory depression]] is feared effect of most | |||
*[[Infection]] | |||
**Local [[cellulitis]] | |||
**[[Meningitis]] | |||
== | ==Evaluation== | ||
==Management== | ==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<ref>Aristedis R, Dimitrios P, Nikolaos P, Alexandros B. Intrathecal baclofen pump infection treated by adjunct intrareservoir teicoplanin instillation. Surg Neurol Int. 2017;8:38.</ref>, but consult ID and/or anesthesia/appropriate surgical specialty as device may need to be removed | |||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Medical device complications]] | *[[Medical device complications]] | ||
*[[Baclofen toxicity]] | |||
==External Links== | ==External Links== | ||
| Line 18: | Line 44: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Surgery]] | |||
[[Category:Neurology]] | |||
Latest revision as of 16:37, 5 November 2025
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
Clinical Features
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
Evaluation
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
Disposition
See Also
External Links
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.