Open AccessSafety and Efficacy of an Outpatient Intrathecal Catheter Trialing Method for Targeted Drug Delivery
Author(s) -
Vipul Mangal
Publication year - 2017
Publication title -
interventional pain management reports
Language(s) - English
Resource type - Journals
ISSN - 2575-9841
DOI - 10.36076/pmcr.2017/1/125
Subject(s) - medicine , ambulatory , catheter , adverse effect , emergency department , infusion pump , opioid , retrospective cohort study , ambulatory care , anesthesia , chronic pain , emergency medicine , surgery , health care , physical therapy , nursing , receptor , economics , economic growth
Background: Chronic pain is a significant healthchallenge, and targeted drug delivery (TDD) isincreasingly utilized to manage patients whohave failed several treatment modalities. Anintrathecal trial is mandatory prior to permanentimplantation, with current guidelines recommendinginpatient observation of 23 hours or inpatientadmission for a continuous intrathecal infusionopioid trial.Objectives: TDD is an established method of thedelivery of opioids, and in this study, we aim toprovide a safe methodology using an outpatientprotocol.Study Design: The study is designed as a retrospectiveanalysis on all non-malignant chronicpain patients who were candidates for TDD, whounderwent an outpatient catheter trial from January1, 2015 to December 31, 2016.Setting: The study took place in an outpatientbasedcommunity practice.Methods: A retrospective chart review andpatient experience questionnaire were utilizedto assess the safety and efficacy of 98 patientswho underwent an intrathecal continuous infusioncatheter trial as an outpatient. The patientsunderwent an intrathecal catheter placement atthe L2/3 interlaminar space with the catheter tipat T10, regardless of pathology. The patientswere connected to an ambulatory pump andwere monitored as an outpatient for up to 3 days.Results: Ninety of the 98 patients had greaterthan 50% pain relief and proceeded to a permanentintrathecal pump implant. The averageeffective dose of morphine or hyrdromorphonewas 480 mcg/day. Using our outpatient and dosagemethodology, 0 patients had serious adverseevents which include infection, self-reported orcaregiver-reported respiratory difficulty, or anemergency room (ER) visit during the trial.The most common adverse events were postdural-puncture headache (PDPH), which occurredin 41% of the patients, nausea/vomiting in 28%of the patients, and catheter dislodgment in 18%of the patients.Limitations: The sample size can be increasedto further prove safety. A multicenter study wouldalso prove to be a benefit.Conclusion: Based on this study, we have deviseda safe and efficacious methodology forperforming an outpatient intrathecal trial usinga continuous infusion catheter, using low doses.Implanted drug delivery systems are being increasinglyutilized for chronic non-malignant pain,and this study implements a safe methodology.This study hopes to provide better patient accessor an alternative to inpatient intrathecal infusiontrials, which can be cumbersome.Key words: Targeted drug delivery, pump trial,intrathecal opioid, intrathecal infusion, outpatienttrial, chronic non cancer pain