Intrathecal drug delivery system complications

Background

• Used for delivery of short or long acting pain or anti-spasmodic medications into the thecal space
• Allows for smaller doses and fewer systemic side effects
• Most common Intrathecal medications
  • Clonidine
  • Bupivacaine
  • Morphine
  • Hydromorphone
  • Fentanyl
  • Baclofen
  • Ziconotide

Differential Diagnosis

Complications:

• Overdose of medication, see:
  • Opioid toxicity
  • Clonidine toxicity
  • Local anesthetic toxicity
  • Baclofen toxicity
  • Respiratory depression is feared effect of most
• Infection
  • Local cellulitis
  • Meningitis

Management

• The device is not removed in an overdose but should be turned off.
• Insertion of a 22-guage needle into the pump reservoir can remove all medication in case device cannot be turned off
• Consider naloxone to reverse effects taking into account patients chronicity of treatment if they withdrawal

See Also

• Medical device complications