frequent procedures
 

INTRATHECAL INFUSION THERAPY (IMPLANTABLE)
Intrathecal infusion therapy is a tertiary stage in managing patients with chronic pain who have exhausted other interventional therapies and procedures or have contraindications to them, and therefore have been managed with oral narcotics for a prolonged period of time at high doses and will prefer to have this treatment done by intrathecal infusion therapy in order to improve their quality of life and minimize the side effects, especially gastrointestinal and C & S side effects of long-term oral narcotic therapy. It can also be used to manage people who have been in chronic spasms, as in quadriplegics and paraplegics, and other musculoskeletal situations that might benefit from use of potent medications like baclofen therapy infusion in order to achieve a better quality of life and reduce the pain in these patients.

The actual procedure involves a test dose with the agent in question. With respect to narcotic infusion therapy, morphine sulfate is often an agent of choice and given in very low doses intrathecally as a test dose to evaluate patient response to therapy and tolerance. The patient also may be given other narcotics if allergic to morphine, including Dilaudid intrathecal injection. These agents may be combined with local anesthetics eventually when intrathecal infusion therapy is started after inserting a catheter into the patient's intrathecal space and then implanting a reservoir usually into the patient's abdominal wall anterolaterally through which a computer-controlled device releasing the medication in specific volumes at specific intervals and at specific times that are programmed. The actual concentration of the mixture of solution that is injected and is in the reservoir of this pump is the responsibility of the physician and the patient with each situation being compounded under aseptic conditions and delivered to control pain and spasms, as the case may be. In the same light, baclofen infusion therapy can also be accomplished alone or in combination with local anesthetic in these patients in the same manner. All of these procedures are done under aseptic conditions and in the usual operating room setting.

CONTRAINDICATIONS: Immuno-compromised patients, which may include patients under chronic dialysis, long-term chronic diabetics as well as patients with immunoglobulin deficiency or patients with HIV/AIDS, are not good candidates for this therapy.

COMPLICATIONS: Complications include meningitis, respiratory depression when narcotics are used and the doses of narcotics are in excess of requirement authorability. Other complications include infection of the reservoir site as well as kinking and blockage of the connecting catheter delivering device.

SEDATION: The actual procedure is done usually under monitored anesthesia care and in a sterile operating room setting with the patient being managed by an anesthesiologist while the actual surgical procedure is being undertaken by the pain specialist.
 

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