There are two type of intrathecal drug delivery system one is external infusion pump and other is implantable pump in our body.
Intrathecal implantable pump
A spinal infusion pump implant, commonly known as a morphine pump, is a specialized device, which delivers concentrated amounts of medication into the spinal fluid space via a small catheter. The intrathecal space is the sac that contains the spinal fluid. The spinal infusion pump is also known as an intrathecal infusion pump.
Spinal infusion pump implants are offered to patients with chronic and severe pain, who have not adequately responded to other, more conservative, treatments. Some examples of diagnoses for which a spinal infusion pump might be used include failed back syndrome, post-laminectomy syndrome, cancer pain, RSD, and severe osteoporosis or end-stage arthritis. Usually these patients cannot be easily controlled on oral pain medications. Thus, to control their pain, these patients may benefit from a continuous spinal infusion of pain medication, usually morphine. Patients have to also meet certain other screening criteria before a spinal infusion pump is implanted.
Purpose of a spinal infusion pump
The spinal infusion pump delivers concentrated amounts of medication into the spinal fluid, thus continuously bathing the pain receptors on the spinal cord with pain medication. This allows the patient to eliminate or substantially decrease the need for oral medications for pain. It delivers medication around the clock, thus eliminating or minimizing breakthrough pain and other symptoms.
It is done with the patient lying on the side. Sometimes the tubing is placed with the patient in the prone position. The patients are monitored with EKG, blood pressure cuff and an oxygen-monitoring device. The skin is cleaned with antiseptic solution and then the procedure is carried out. X-ray is used to guide the introducer needle for inserting the infusion catheter. Once the catheter is in good position, a plastic anchor is used to attach the infusion catheter to the spinal ligaments. Then a tunnel is made from the back to the lower abdomen with a special tunneling tool. A pocket under the skin is made in the lower abdomen into which the infusion pump will be placed. The pump is filled with morphine and the catheter is attached to the pump. Once this is done, the incisions are sewn shut and bandages applied.
Post procedure advise
This procedure is normally an outpatient procedure. Many patients go home several hours after the pump is inserted. Some patients are kept overnight for observation and pump adjustment. Someone will need to drive the patient home. Patients going home the night of the surgery should not be alone the first night. All patients will be advised to take it easy for several days. Ice may be used for swelling around the pump and some patients are asked to wear a soft abdominal binder as a sort of pressure dressing over the pump. Antibiotic pills are given to decrease the risk of infection. The physician will check the wound in about three to five days. If the wound is dry, the dressings will probably be removed at that time. The stitches will be removed in about two weeks or so.
How long will the spinal infusion pump last?
The medication contained within the pump will last about 1 to 3 months depending upon the concentration and amount infused. It is then refilled via a tiny needle inserted into the pump chamber. This is done in the office or at your home and it takes only a few minutes. The batteries in the pump may last 3 to 5 years depending upon the usage. The batteries cannot be replaced or recharged. The pump must be replaced at that time.