Usefulness of ultrasound: intrathecal pump refill in the management of chronic pain. A case report

  • Jairo Santiago García-Eslava School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
  • Julián E. Barahona-Correa School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
  • Diego Alberto Moreno a. Department of Anesthesiology, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia. b. Pain Clinic, Hospital Universitario San Ignacio, Bogotá, Colombia
  • Antonio Bonilla a. Department of Anesthesiology, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia. b. Pain Clinic, Hospital Universitario San Ignacio, Bogotá, Colombia
Keywords: Pain; Ultrasonography; Chronic Pain; Analgesics; Infusion Pumps

Abstract

Intrathecal administration for the treatment of patients with difficult to manage chronic pain represents a therapeutic breakthrough that reduces adverse effects and improves the patient's quality of life. However, the use and refill of infusion pumps entails certain risks. A difficult access to the refill port and the potential for subcutaneous infiltration are rare but potentially fatal complications. The use of ultrasonography as real-time guidance for the localization of the port has been suggested. The case of a patient with a diagnosis of ankylosing spondylitis and chronic pain, with neuroplasticity phenomena in the management of analgesia with opioid intrathecal infusion pump and the need for frequent refill is discussed. An ultrasound-guided static method using coordinates was used for a successful, free of complications refill. The technique described for the refill of intrathecal infusion pumps is a practical and innovative approach which, through adequate training, may reduce the risks and complications during the procedure in patients requiring frequent refills.

References

1. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain-United States, 2016. JAMA 2016;315: 1624-1645.
2. Zheng S, He L, Yang X, et al. Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies: a prospective cohort study. Medicine (Baltimore) 2017;96: e6354.
3. Hayek SM, Deer TR, Pope JE, et al. Intrathecal therapy for cancer and non-cancer pain. Pain Physician 2011;14:219-248.
4. Smith TJ, Swainey C, Coyne PJ. Pain management, including intrathecal pumps. Curr Pain Headache Rep 2005; 9:243248.
5. Rizvi S, Kumar K. History and present state of targeted intrathecal drug delivery. Curr Pain Headache Rep 2015;19:474.
6. Medtronic. Synchromed (r) II 8637 Internet. 2003. Available at: http://www.neuromodulation.ch/sites/default/files/pictures/synchromed_II_implant_manuel.pdf. Accessed August 30, 2017.
7. Maino P, Koetsier E, Perez RS. The accuracy of template-guided refill technique of intrathecal pumps controlled by fluoroscopy: an observational study. Neuromodulation 2015;18:428-432.
8. Gofeld M. Ultrasonography in pain medicine: a critical review. Pain Pract 2008;8:226-240.
9. Christensen K, Doblhammer G, Rau R, et al. Ageing populations: the challenges ahead. Lancet 2009;374:1196-1208.
10. Medtronic. Medtronic Product Performance Report Internet. 2016. Available at: https://professional.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@neuro/documents/documents/mdt_product_performance_2016.pdf. Accessed August 30,2017.
11. Miller DL. Efforts to optimize radiation protection in interventional fluoroscopy. Health Phys 2013;105:435-444.
12. Smilowitz NR, Balter S, Weisz G. Occupational hazards of interventional cardiology. Cardiovasc Revasc Med. 2013;14: 223-8.
13. Peng P, Soneji N. Ultrasound-guided intervention for pain management. Pain Manag 2014;4:13-15.
14. Shankar H. Ultrasound-guided localization of difficult-to-access refill port of the intrathecal pump reservoir. Neuromodulation 2009;12:215-218.
15. Liu Y, Glass NL, Glover CD, et al. Comparison of the development of performance skills in ultrasound-guided regional anesthesia simulations with different phantom models. Simul Healthc 2013;8:368-375.
16. McVicar J, Niazi AU, Murgatroyd H, et al. Novice performance of ultrasound-guided needling skills: effect of a needle guidance system. Reg Anesth Pain Med 2015;40:150-153.
17. Quintana Puerta JE. Ultrasonography for anesthesiologists. Rev Colomb Anestesiol 2014;42:33-36.
How to Cite
1.
García-Eslava JS, Barahona-Correa JE, Moreno DA, Bonilla A. Usefulness of ultrasound: intrathecal pump refill in the management of chronic pain. A case report. Colomb. J. Anesthesiol. [Internet]. 2018 Jan. 1 [cited 2024 Jul. 22];46(1):68-71. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/329

Downloads

Download data is not yet available.
Published
2018-01-01
How to Cite
1.
García-Eslava JS, Barahona-Correa JE, Moreno DA, Bonilla A. Usefulness of ultrasound: intrathecal pump refill in the management of chronic pain. A case report. Colomb. J. Anesthesiol. [Internet]. 2018 Jan. 1 [cited 2024 Jul. 22];46(1):68-71. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/329
Section
Case Report / Case Series

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code