California Society of Anesthesiologists Bulletin Spring 2013 - (Page 38)
eDucAtiOnAl Article
Intrathecal Drug Delivery
By Tammy J. Penhollow, Do, and einar ottestad, mD
Editor’s note: This educational article is reprinted from a CME module on the CSA website as a service to CSA members who prefer to study CME material via print media. The CME credit associated with the article is provided as a
free member benefit. In order to claim CME credit, the reader MUST visit www.csahq.org/onlineCME, select Pain
Management and End-of-Life Care, and complete the Intrathecal Drug Delivery Test Questions at the end of the module. For convenience, the same questions are printed at the end of the educational article here in the Bulletin. Do NOT
submit the Answer Worksheet to the CSA; any answers recorded on the Answer Worksheet will need to be transferred
to the quiz at the end of the online module.
introduction
Tammy J. Penhollow, DO, a graduate
of the Pain Management Fellowship at
Stanford, is in private practice at Pacific
Pain Treatment Center in San Francisco. Einar Ottestad, MD, is Clinical
Assistant Professor and Director of the
Acute Pain Service in the Department
of Anesthesiology and Pain Medicine at
Stanford University Medical Center.
The first documented spinal analgesia occurred in 1898 when August Bier gave
himself, his assistant and six patients undergoing surgery of the lower body
spinal analgesia with cocaine.1 In subsequent years, the science and application
of neuraxial anesthesia have evolved to the point where since 1981 over 285,000
intrathecal drug delivery (ITDD) systems have been implanted.2 Today’s anesthesiologist is likely to encounter patients with ITDD systems throughout the
perioperative period (preoperative clinic, operating room and procedure suite,
the post anesthesia care unit) and possibly on the hospital ward. The following
educational activity is designed to provide an overview of the indications for
implantable intrathecal devices, patient and medication selection, and relative
risks and contraindications to this treatment modality.
indications
The benefits of ITDD include the ability to provide pain relief for patients
who have failed to achieve adequate relief from conventional therapy. Because
the drug is delivered directly to the nociceptors at the level of the spinal cord,
smaller doses of medication are needed, thereby reducing the probability of oral
opioid adverse effects (constipation, nausea, vomiting, and sedation). Other
goals of therapy include reducing or eliminating the need for oral pain medications and improving activities of daily living and overall function. Lipophilicity
of the medication and catheter tip location determine the site of action within
the CSF. 3
The FDA-approved package insert for the most widely available intrathecal drug
delivery system by Medtronic lists the following medication options and indications: United States: Chronic intraspinal (epidural and intrathecal) infusion of
preservative-free morphine sulfate sterile solution in the treatment of chronic
38
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Table of Contents for the Digital Edition of California Society of Anesthesiologists Bulletin Spring 2013
Editor's Notes
ASA Director's Report
Peering Over the Ether Screen
On Your Behalf: Legislative and Practice Affairs
Education, Hawaii... What Could Be Better?
California and National News
From the Executive Director
2013 CSA Spring Anesthesia Seminar
District Director Reports
Book Review
Educational Article
California Society of Anesthesiologists Bulletin Spring 2013
https://www.nxtbook.com/allen/csab/63-1
https://www.nxtbook.com/allen/csab/62-4
https://www.nxtbook.com/allen/csab/62-3
https://www.nxtbook.com/allen/csab/62-2
https://www.nxtbook.com/allen/csab/62-1
https://www.nxtbook.com/allen/csab/61-4
https://www.nxtbookmedia.com