Surgical Methods for Implanting Intrathecal Medication Delivery Devices

Siva Sree Yarramsetty

doi:10.37022/jis.v7i3.91

Yarramsetty Siva Sree Priyadarshini Institute of Pharmaceutical Education and Research, 5th Mile, Pulladigunta, Guntur-522017.Andhra Pradesh, India.

DOI https://doi.org/10.37022/jis.v7i3.91

Abstract

Patients with chronic pain that is not responding to treatment may benefit from intrathecal drug delivery systems (IDDDS). Current developments in technology, novel therapeutic uses, documented side effects, and the expenses and upkeep associated with this treatment need staying current with new guidelines that could enhance results. When used by qualified practitioners and with medications that have a documented safety record, intrathecal drug delivery devices may be beneficial for patients with a narrow therapeutic safety margin. We go over the most widely used medications (both opioids and non-opiods), their pharmacokinetic and pharmacodynamic properties, and their recommended uses. Morphine, hydromorphone, methadone, fentanyl, bupivacaine, clonidine, and ketamine are the most commonly utilized medications. This chapter examines all technological concerns related to the implantation of IDDS devices, along with follow-up and pharmaceutical recommendations released in recent years that offer an evidence-based approach to decision-making for the treatment of patients' chronic pain and spasticity.

Keywords: Intrathecal drug delivery, chronic pain, opioids

References

1. Alicino I, Giglio M, Manca F, Bruno F, Puntillo F. Intrathecal combination of ziconotide and morphine for refractory cancer pain: a rapidly acting and effective choice. Pain. 2012 Jan 1;153(1):245-9.
2. Alperin N, Bagci AM, Lee SH, Lam BL. Automated quantitation of spinal CSF volume and measurement of craniospinal CSF redistribution following lumbar withdrawal in idiopathic intracranial hypertension. American Journal of Neuroradiology. 2016 Oct 1;37(10):1957-63. https://pubmed.ncbi.nlm.nih.gov/27282859/
3. Bier A. Versuche über cocainisirung des Rückenmarkes Dtsch. Zeitschr Chir. 1899;51:361-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143582/
4. Buchiraju, Ravi; Nama, Sreekanth; Sakala, Bhargavi; Chandu, Babu Rao; Kommu, Arun; Chebrolu, JKB; Narasimhamurthy, Y; Vesicular drug delivery system-an over view Res J Pharm Biol Chem Sci 43462-74 2013
5. Bolash R, Mekhail N. Intrathecal pain pumps: indications, patient selection, techniques, and outcomes. Neurosurgery Clinics. 2014 Oct 1;25(4):735-42. https://pubmed.ncbi.nlm.nih.gov/25240660/
6. Grady K. Intrathecal Drug Delivery for the Management of Pain and Spasticity in Adults: Recommendations for best clinical practice. British Pain Society; 2008.. https://www.britishpainsociety.org/static/uploads/resources/files/itdd_2015_pro_v3.pdf
7. Buchser E, Durrer A, Chédel D, Mustaki JP. Efficacy of intrathecal bupivacaine: how important istheflowrate?.PainMedicine.2004Sep1;5(3):24852 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246706/
8. Avinash M, Suryaprabha M, Sreekanth N, Dineshreddy B, Baburao CH. Advanced and Recent Emerging Trends in Insulin Dru g Delivery Systems. International Journal of Bio-Pharma Research. 2012;1.
9. Deer TR, Pope JE, Hayek SM, Bux A, Buchser E, Eldabe S, De Andrés JA, Erdek M, Patin D, Grider JS, Doleys DM. The Polyanalgesic Consensus Conference (PACC): recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation: Technology at the Neural Interface. 2017 Feb 1;20(2):96-132. https://pubmed.ncbi.nlm.nih.gov/28042904/
10. Nanjwade BK, Bechra HM, Derkar GK, Manvi FV, Nanjwade VK. Dendrimers: emerging polymers for drug-delivery systems. European Journal of Pharmaceutical Sciences. 2009 Oct 8;38(3):185-96.
11. Rani TT, Brahmaiah B, Revathi B, Nama S, Baburao C. TARGETING OF ANTI CANCER DRUGS THROUGH NANOPARTICLES.
12. Amulya A, Sirisha V, Rao CB, Chennam JV. CURRENT TRENDS ON ROLE OF NANO PARTICLES ON PULMONARY DISEASES. International Journal of Research in Pharmacy and Chemistry. 2012; 2(3):685-703.
13. Deer TR, Smith HS, Burton AW, Pope JE, Doleys DM, Levy RM, Staats PS, Wallace MS, Webster LR, Rauck RL, Cousins M. Comprehensive consensus based guidelines on intrathecal drug delivery systems in the treatment of pain caused by cancer pain. Pain physician. 2011;14(3):E283.
14. Emami A, Tepper J, Short B, Yaksh TL, Bendele AM, Ramani T, Cisternas AF, Chang JH, Mellon RD. Toxicology evaluation of drugs administered via uncommon routes: intranasal, intraocular, intrathecal/intraspinal, and intra-articular. International journal of toxicology. 2018 Jan;37(1):4-27.
https://journals.sagepub.com/doi/full/10.1177/1091581817741840
15. Gold MS, Reichling DB, Hampl KF, Drasner K, Levine JD. Lidocaine toxicity in primary afferent neurons from the rat. Journal of Pharmacology and Experimental Therapeutics. 1998 May 1;285(2):413-21.
https://jpet.aspetjournals.org/content/285/2/413.short
16. Johansen MJ, Satterfield WC, Baze WB, Hildebrand KR, Gradert TL, Hassenbusch SJ. Continuous intrathecal infusion of hydromorphone: safety in the sheep model and clinical implications. Pain Medicine. 2004 Mar 1;5(1):14-25.
17. Kim D, Saidov A, Mandhare V, Shuster A. Role of pretrial systemic opioid requirements, intrathecal trial dose, and non-psychological factors as predictors of outcome for intrathecal pump therapy: one clinician’s experience with lumbar postlaminectomy pain. Neuromodulation: Technology at the Neural Interface. 2011 Apr 1;14(2):165-75.
https://www.sciencedirect.com/science/article/abs/pii/S1094715911600329
18. Kalichman MW. Physiologic mechanisms by which local anesthetics may cause injury to nerve and spinal cord. Regional Anesthesia and Pain Medicine. 1993 Nov 1;18(Suppl 6):448-52.