The spinal infusion systems include intrathecal and epidural infusion devices. There are two types of spinal infusion pumps: programmable and non-programmable. The programmable pump is a computerized, battery-operated device (that can dispense medication at different rates throughout the day as well as deliver a bolus). The non-programmable pumps are available in different sizes and different (but fixed) rates. A spinal infusion system consists of a pump and a catheter, both of which are surgically placed under the skin. The catheter is inserted into the intrathecal space and connected to the pump that is implanted into the subcutaneous tissue of the abdomen.
The pump releases medication through the catheter into the subarachnoid space. Currently, preservative-free morphine, baclofen, and fentanyl are the only Food and Drug Administration approved medicines that can be infused into human spinal fluid.
Indications
Intrathecal infusion of preservative-free morphine or fentanyl is designed for patients who suffer from chronic malignant or non-malignant intractable pain. They have failed all types of pain treatment, including physical modalities, manipulations, injections, surgery, and other adjuvant treatments, and the patient selected for the infusion pump should be free of drug dependence, be psychologically suitable and stable, and be a highly motivated individual.
Abdominal pain due to gastrointestinal malignancy is characterized by severe epigastric pain with radiation to the back . The procedure is performed in an outpatient setting. The treatment is done with local anesthesia along with IV sedation when needed. The patient is placed prone and landmarks were drawn with a skin marker. The site for needle entry was marked on the left and right side of the patient, 5 to 6cm lateral from the spinous process of L1 Vertebral body. The skin and deeper tissues were infiltrated with 2% lidocaine using a spinal needle under the fluoroscopic guidance. The contrast solution (Omnipaque) 4 ml was injected through the needle. The spread of the dye was confirmed under fluoroscopy, then neurolysis was carried out through injection of 25 ml of 95% alcohol diluted with equal volume of 0.5% bupivacaine through the two needles (total volume 50 ml). The needle was removed and puncture site was sterilized and covered.
