It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology...
Transcript of It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology...
![Page 1: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/1.jpg)
It’s Just Another Patient with Back Pain!
Intrathecal Delivery Device Complications Linda L. Herman, MD, FACEP
Program Director
KDHCD Emergency Medicine Residency Program
![Page 2: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/2.jpg)
Objectives
List the indications for intrathecal pain management delivery systems
Recognize the signs and symptoms of intrathecal delivery system (ITDS) dysfunction and treat the patient appropriately
Choose the correct diagnostic test to determine what complication is present
Name the treatment for the complications
![Page 3: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/3.jpg)
Indications
▶ Chronic
intractable pain
▶ Treatment of
spasticity
related to
neuromuscular
diseases
![Page 4: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/4.jpg)
What is a pain pump?
![Page 5: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/5.jpg)
Refilling the pump
![Page 6: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/6.jpg)
What Medications?
FDA approved
▶ Morphine (infumorph)
▶ Ziconotide (Prialt)
▶ Baclofen (Lioresal,
Gablofen)
Unapproved but used
▶ Levobuivacaine
▶ Bupivicaine
▶ Hydromorphone
▶ Clonidine
▶ Midazolam
▶ Methadone
![Page 7: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/7.jpg)
▶ 46 yo female comes to the ED with husband with AMS
which began this the PM PTA
▶ Had intrathecal pump system revised the day prior to
admission. Receives Baclofen for spasticity of cerebral
palsy
▶ 100.8 rectally – 112 – 22 – 150/92
▶ Neuro – confused, agitated, CN grossly intact, MOE X 4,
rigid extremities
![Page 8: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/8.jpg)
Pump malfunction
Underdosing Overdosing
![Page 9: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/9.jpg)
Overdosing
▶ Symptoms
▶ Somnolent
▶ Lethargic
▶ Respiratory
depression
▶ Treatment
▶ Naloxone
▶ Airway & ventilatory
support
▶ Removal of CSF
![Page 10: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/10.jpg)
Baclofen Overdose
Symptoms▶ Flaccidity
▶ Hyporeflexia
▶ Respiratory depression/Apnea
▶ Seizures
▶ Coma
▶ Autonomic Instability
▶ Hallucinations
▶ Hypothermia
▶ Cardiac Conduction Abnormalities
Treatment▶ Intubate
▶ Empty the pump
▶ Turn off the pump
▶ CSF withdrawal
▶ Vasopressors
Shirley KW et al. Intrathecal baclofen
overdose and withdrawal. Pediatr Emerg
Care. 2006;22(4):258-261.
![Page 11: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/11.jpg)
Underdosing for pain medication
▶ Symptoms
▶ Increased pain
▶ Treatment
▶ Supplemental
treatment
![Page 12: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/12.jpg)
Baclofen withdrawal
▶ Symptoms
▶ High fever
▶ Increased spasticity
▶ Muscle rigidity
▶ AMS
▶ Treatment
▶ Fluids
▶ Benzodiazepine
▶ External cooling
![Page 13: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/13.jpg)
Call the doctor who inserted
the pump!
I’ll help you!
![Page 14: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/14.jpg)
Palpate the location of the pump
![Page 15: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/15.jpg)
Order an x-ray
![Page 16: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/16.jpg)
Migration
![Page 17: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/17.jpg)
Disconnected
![Page 18: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/18.jpg)
Catheter
Migration
![Page 19: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/19.jpg)
Interrogate
the pump
![Page 20: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/20.jpg)
Check the reservoir
![Page 21: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/21.jpg)
Ultrasound
Maneyapanda MB, Chang Chien GC, Mattie R, Amorapanth P, Reger C, McCormick ZL:
Ultrasound guidance for technically challenging intrathecal baclofen pump refill: three
cases and procedure description. Am J Phys Med Rehabil 2016
![Page 22: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/22.jpg)
CT scan
Morgalla, M, Fortunato M ,
Azam A, et. al. “High-
Resolution Three-Dimensional
Computed Tomography for
Assessing Complications
Related to Intrathecal Drug
Delivery.” Pain Physician
2016; 19:E775-E780•
![Page 23: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/23.jpg)
Contrast Enhanced
![Page 24: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/24.jpg)
Intracranial Hypotension
Syndrome
▶ Symptoms
▶ HA
▶ Neck pain/stiffness
▶ N/V
▶ Change in hearing
▶ Vertigo
▶ Sense of imbalance
▶ Treatment
▶ Bedrest
▶ Caffeine
▶ Fluids
▶ Blood patch
![Page 25: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/25.jpg)
Subdural
▶ Rare
▶ Headaches & nausea after
implantation
▶ Altered LOC several weeks
later
https://en.wikipedia.org/wiki/Subdural_hematoma
Magro E, et. al. “Bilateral Subdural
Hematoma Following Implanatation of
Intrathecal Drug Delivery Device.”
Neuromodulation 2011;14:179-182.
![Page 26: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/26.jpg)
Infection
![Page 27: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/27.jpg)
Infection Intrathecal space
▶ Symptoms
▶ Encephalitis
▶ Meningitis
▶ Treatment
▶ IV Antibiotics
▶ Removal
![Page 28: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/28.jpg)
Epidural
Abscess
▶ Symptoms
▶ fever
▶ Increase in pain
▶ Urinary incontinence
▶ Paresis or paralysis
▶ Perineal anesthesia
▶ Decreased rectal tone
▶ Treatment
▶ IV antibiotics
▶ Surgery
![Page 29: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/29.jpg)
Hemorrhage
![Page 30: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/30.jpg)
Catheter Tip Granuloma
Narouze S, Casanova J, Souzdalnitski D. “Patients with a History of Spine Surgery or
Spinal Injury may have a higher Chance of Intrathecal Catheter Granuloma
Formation.” Pain Practice 2014;14(1): 57 -63.
![Page 31: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/31.jpg)
![Page 32: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/32.jpg)
Rhabdomyolysis
▶ Ziconotide
▶ Elderly
▶ Treatment
▶ Fluids
▶ Stop the med
Horazeck C, et.al. “Acute Rhabdomylolysis in a
Patient with Long-Term Exposure to Intrathecal
Ziconotide: A Case Report.” Pain Practice 2015;
15(1):E34.
![Page 33: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/33.jpg)
Twiddler’s syndrome
▶ Described in 1968 w/
pacemakers
▶ 3 cases reported
Shao, Jianning,et.al. (2018). Occlusion of the Ascenda Catheter in a Patient
with Pump Twiddler’s Sydrome: A Case Report. Anesthesiology and Pain
Medicine. I
![Page 34: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/34.jpg)
Harlequin Syndrome
▶ Symptoms
▶ Hemifacial flushing
▶ Relative hyperhidrosis
▶ Related to combo of meds
▶ Clonidine
▶ Bupivicaine
▶ Hydromorphone
Zinboonyahgoon N, et. al. “Harlequin Syndrome Following
Implantation of Intrathecal Pumps: A Case Series.”
Neuromodulation: Technology at the Neural Interface 2015;
18: 772–775.
![Page 35: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/35.jpg)
Williams BS, et.al. “Case Scenario:
Self-extraction of Intrathecal Pump
Medication with a Concomitant
Intrathecal Granulomatous Mass”
Anesthesiology 2 2011, Vol.114, 424-
430.
![Page 36: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/36.jpg)
Can you send this Patient to
the MRI?
![Page 37: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/37.jpg)
Can other items cause the
pump to stall?
Huh B, Roddan CJ. “Magnetic
fields and intrathecal pump
malfunction.” American
Journal of Emergency Medicine
2016;34:115e5-115e6.
![Page 38: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/38.jpg)
Figure 1
Annals of Emergency Medicine 2018 71, 467-469DOI: (10.1016/j.annemergmed.2017.07.009)
Copyright © 2017 American College of Emergency Physicians Terms and Conditions
Arrhythmia?
Resuscitation of a Patient With an Implanted Electronic Device . Leopold Simma, MD, Matteo Fontana, MD,
Thomas Schmitt-Mechelke, MD . Annals of Emergency Medicine Volume 71, Issue 4, Pages 467-469 (April
2018)
![Page 39: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/39.jpg)
![Page 40: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/40.jpg)
Bibliography▶ “Baclofen – FDA prescribing information, side effects, and uses.”
https://www.drugs.com/pro/baclofen.html. Accessed on July 16, 2018. Update June 4, 2018.
▶ Bayliss CE, Beanlands DS, Baird RJ. The pacemaker-twiddler's syndrome: a new complication of implantable transvenous pacemakers. Can Med Assoc J 1968;99:371-373.
▶ Borrini L, Bensmail D, Theibaut J, et. al. “Occurrence of Adverse Events in Long-term Intrathecal Baclofen Infusion: A 1-Year Follow-UP Study of 158 Adults.” Archives of Physical Medicine and Rehabilitation 2014;85:1032-1038.
▶ Dovanda TJ, Pestereva E, Lee A. “Intrathecal Baclofen Pump Migration Into the peritoneal Cavity Case Report.” Anesthesia Pain Medicine 2016 June;6(3):e33031.
▶ Han JL, Loriaux DB, Tybout C, et. al. “Thoracic Nerve Root Entrapment by Intrathecal Catheter Coiling: Case Report and Review of the Literature.” Pain Physician 2016;19: E499 – E504
▶ Heo BH, et al. “Epidural Infusion of Morphine and Levobupivacaine through a Subcutaneous Port for Cancer Pain Management” Korean Journal of Pain 2014;27 (2):139.
▶ Horazeck C, Huh AS, Huh BK. “Acute Rhabdomylolysis in a Patient with Long-Term Exposure to Intrathecal Ziconotide: A Case Report.” Pain Practice 2015; 15(1): E34.
![Page 41: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/41.jpg)
Bibliography▶ Magro E, et. al. “Bilateral Subdural Hematoma Following Implanatation of
Intrathecal Drug Delivery Device.” Neuromodulation 2011;14:179-182.
▶ Maino P, et. al. “Fentanyl Overdose Caused by Malfunction of SynchroMed II Intrathecal Pump.” Regional Anesthesia and Pain Medicine 2014 Sept-Oct; 13(5):434 – 437.
▶ Maneyapanda MB, Chang Chien GC, Mattie R, Amorapanth P, Reger C, McCormick ZL: Ultrasound guidance for technically challenging intrathecal baclofen pump refill: three cases and procedure description. Am J Phys Med Rehabil 2016;95:692Y697.
▶ Moens M, DeSmedt A, Duerinck J, D/Haens J, Brouns R. “Twiddler's Syndrome Complicating Neuromodulation Systems For Chronic Pain.” World of Neurosurgery. 2012 January;77 (1): 213.
▶ Morgalla, M, Fortunato M , Azam A, et. al. “High-Resolution Three-Dimensional Computed Tomography for Assessing Complications Related to Intrathecal Drug Delivery.” Pain Physician 2016; 19:E775-E780• ISSN 2150-114.
▶ Narrang S, Srinisavan SK, Zinboonyahgoon N, et. al. “Upper Antero-Medial Thigh as an Alternative Site for Implantation of Intrathecal Pumps: A Case Series.” Neuromodulation 2016;19:655-663.
▶ Narouze S, Casanova J, Souzdalnitski D. “Patients with a History of Spine Surgery or Spinal Injury may have a higher Chance of Intrathecal Catheter Granuloma Formation.” Pain Practice 2014;14(1): 57 -63.
▶ Padalia D, Jassal N, Patel S. “Near Death Experience from Placement of an Intrathecal Catheter.” Pain Physician 2016;19:E621-E623.
![Page 42: It’s Just Another Patient with Back Pain! Intrathecal Delivery ......Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775. Williams BS, et.al. “Case Scenario:](https://reader033.fdocuments.in/reader033/viewer/2022050602/5fa988e61b91963d71239ddc/html5/thumbnails/42.jpg)
Bibliography▶ Perruchoud C, Bovy M, Rutschmann B, et. al. “Silicone Septum Leakage at the Origin of a Drug
Overdose in a Patient with Implanted with an Intrathecal Pump.” Neuromodulation 2013;16:467 – 470.
▶ Pope JE, Deer TR. “Guide to Implanatable Devices for Intrathecal Therapy.” https://www.practicalpainmanagement.com/treatments/interventional/pumps/guide-implantable-devices-intrathecal-therapy?page=0,1. Accessed on August 28, 2017. Updated on September 25, 2013.
▶ Shao, Jianning & Frizon, Leonardo & Machado, Andre & McKee, Keith & Bethoux, Francois & Hartman, Jennifer & J. Nagel, Sean. (2018). Occlusion of the Ascenda Catheter in a Patient with Pump Twiddler’s Sydrome: A Case Report. Anesthesiology and Pain Medicine. In Press. 10.5812/aapm.65312.
▶ Shirley KW et al. Intrathecal baclofen overdose and withdrawal. Pediatr Emerg Care. 2006;22(4):258-261. PMID: 16651918
▶ Stetkarova I, Brabec K, Vasko P, et.al. “Intrathecal Baclofen in Spinal Spasticity: Frequency and Severity of Withdrawal Syndrome.” Pain Physician 2015; 18:E633-E641 • ISSN 2150-1149.
▶ Swaminathan, A. “Rebel EM: Baclofen Withdrawal” http://rebelem.com/baclofen-withdrawal/Accessed on July 16, 2018. Updated on October 27, 2016.
▶ Varhabhatla N, Zuo Z. “Rising Complication Rates After Intrathecal Catheter and Pump Placement in the Pediatric Population: Analysis of National Data Bank Between 1996 and 2006.” Pain Physician 2012; 15:65 -74.
▶ Vivek V, Kavar B, Hogg M, Eisen DP, Butzxkueven. “Asperigillus arachnoiditis post intrathecal baclofen pump insertion.” Journal of Clinical Neuroscience 2013; 20:1159 – 1160.
▶ Williams BS, Wong D, Amin S. Case Scenario: Self-extraction of Intrathecal Pump Medication with a Concomitant Intrathecal Granulomatous Mass. Anesthesiology 2 2011, Vol.114, 424-430.
▶ Zinboonyahgoon N, et. al. “Harlequin Syndrome Following Implantation of Intrathecal Pumps: A Case Series.” Neuromodulation: Technology at the Neural Interface 2015; 18: 772–775.