Intrathecal Medication Pumps
Why is this surgery done?
An intrathecal pump or a “pain pump” delivers small amounts of medicine into the spinal fluid. By giving the medicine in smaller doses, the side effects are lessened.
The pump is indicated in patients that have failed the usual treatment for pain or spasticity.
Patients with spasticity have a medication called baclofen infused. The FDA has approved the use of morphine and ziconotide in the pump. Other opioids (dilaudid or fentanyl) or spinal anesthetics (bupivacaine) are used in the pump if the pain physician feels they are necessary.
Can assist with activities of daily living, positioning and overall quality of life improvements.
How is the surgery done?
Prior to implanting the pump, the patient will undergo a test dose. A lumbar puncture (spinal tap) is done under local anesthesia and a small dose of medication is placed into the spinal fluid. The patient then rates the response to pain or spasticity. The effect of the test dose lasts 4 – 8 hours. If the response is positive, the implant surgery is scheduled. If not, often a second test with a larger dose of medication is done.
The pump implant surgery is usually done using general anesthesia in the operating room. A thin tube (catheter) is placed into the spinal fluid space through a needle using x-ray guidance. A small incision in the back is made to anchor the tube under the skin. A second incision is made in the belly wall to make a pocket for the pump under the skin. The pump is about the size of a hockey puck. The catheter is then tunneled under the skin from the back incision to the pump pocket and connected to the pump. Prior to the implant, the pump will be filled with the appropriate drug. The pump is then programmed by the doctor using a device that looks like an iPad.
What are my risks? What are common complications?
With any surgery, there are risks. You should talk with your doctor about them.
Complications are rare. They include the usual risks of surgery under general anesthesia, infection, dislodgement of the catheter from the spine, spinal headache and leaking of spinal fluid from the wound.
What do I need to know before surgery?
Intrathecal medication is a long-term therapy. It takes a team of people to not only perform surgery successfully, but also make sure good care is provided after surgery. Goodman Campbell Brain and Spine has one of the largest and most experienced adult neurosurgical practices treating patients with intrathecal medication pumps.
You will be asked to answer a lot of questions and may have other tests done before surgery. You should follow all instructions given to you before surgery. The amount of time you will spend in the hospital is often three days and depends on many things, including your general health before the surgery. It is very important that you do not take any blood thinning medication for one week before your surgery. This includes any vitamins, herbs or supplements which may have blood thinning components in them. Do not restart blood thinners after surgery until your physician approves.
The pumps need to be refilled with medication, usually every 3 – 6 months depending on the dose you are getting. Refills can be done in our office or by a home health service. Refills involve placing a needle through the skin into the pump and injecting the medicine into the pump.
General discharge instructions
Your healthcare provider will give you specific instructions when leaving the hospital. In general, shower or sponge bath daily, keeping your incisions clean with soap and water — but do not immerse or soak your incisions under water. (Do not take a bath or swim.) Do not touch or scratch your incisions. Avoid straining or lifting heavy objects. Eat a well-balanced diet to help with healing. Make sure someone looks at your incisions every day and contacts your doctor’s office with any concerns. Most patients can resume normal activity a few weeks after surgery.
What should I expect while recovering?
You may be sore between your different incisions where the catheter was passed under the skin. This is temporary and will get better over time. You may feel more tired when first returning home. Be sure to rest. However, you should try to do some daily activity. Walking is one of the best ways to start feeling better and should be done routinely and for longer periods of time as you feel better.