게시판
| 21KS-004 |
Repetitive obstruction of an intrathecal catheter in a patient with intrathecal drug delivery system.
Department of Anesthesiology and Pain Medicine, Seoul St. Mary s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Introduction:
Intrathecal drug delivery system(IDDS) is a proven method in its efficacy and safety for the treatment of patients with chronic intractable pain over oral analgesics. We present a case of repeated loss of effectiveness of the IDDS and its cause assumed to be temporary obstruction of the catheter.
Case report:
A 43-year-old male patient with intractable epigastric pain had received intrathecal morphine pump implantation to alleviate his pain and reduce side effects. Three months after receiving the procedure, he complained of a sudden worsening of pain without neuronal motor or sensory loss. To scrutinize the cause of exacerbating pain, we investigated the IDDS following the protocols suggested by Bardutzky et al. We interrogated the pump programming and its filling status first. There was no significant difference between the actual volume and the expected volume. After that, we aspirated the cerebrospinal fluid (CSF) through the catheter access port (CAP) to confirm the patency of the catheter. CSF was aspirated easily. In the roller study for the SynchroMed II system, the 120˚ angular rotation by the programmed bolus was confirmed. We could not also find out any fracture or kink of the catheter by injecting non-ionic contrast media into the subarachnoid space through the CAP in dye study. His pain was controlled well for several months, then repetitively aggravated. Despite pulling the catheter back a few centimeters, the pain recurred. We decided to investigate its system surgically considering the possibility of the catheter obstruction. During surgery, we pulled out the catheter and found no defects with the catheter. After the replacement of the catheters, NRS for pain decreased below 3/10, and he regularly visits the outpatient clinic to check the function of the IDDS and refill the medication.
Conclusion:
In the case where the IDDS effect suddenly disappears, considering the catheter replacement may be the final option if all troubleshooting steps were failed to prove mechanical defects in the Intrathecal drug delivery system.
References
1. Bardutzky J et al. Intrathecal baclofen for stiff-person syndrome: life-threatening intermittent catheter leakage. Neurology 2003;60:1976-1978.
2. Rhee SM et al. Catheter obstruction of intrathecal drug administration system. Korean J Pain 2012;25(1):47-51.
Intrathecal drug delivery system(IDDS) is a proven method in its efficacy and safety for the treatment of patients with chronic intractable pain over oral analgesics. We present a case of repeated loss of effectiveness of the IDDS and its cause assumed to be temporary obstruction of the catheter.
Case report:
A 43-year-old male patient with intractable epigastric pain had received intrathecal morphine pump implantation to alleviate his pain and reduce side effects. Three months after receiving the procedure, he complained of a sudden worsening of pain without neuronal motor or sensory loss. To scrutinize the cause of exacerbating pain, we investigated the IDDS following the protocols suggested by Bardutzky et al. We interrogated the pump programming and its filling status first. There was no significant difference between the actual volume and the expected volume. After that, we aspirated the cerebrospinal fluid (CSF) through the catheter access port (CAP) to confirm the patency of the catheter. CSF was aspirated easily. In the roller study for the SynchroMed II system, the 120˚ angular rotation by the programmed bolus was confirmed. We could not also find out any fracture or kink of the catheter by injecting non-ionic contrast media into the subarachnoid space through the CAP in dye study. His pain was controlled well for several months, then repetitively aggravated. Despite pulling the catheter back a few centimeters, the pain recurred. We decided to investigate its system surgically considering the possibility of the catheter obstruction. During surgery, we pulled out the catheter and found no defects with the catheter. After the replacement of the catheters, NRS for pain decreased below 3/10, and he regularly visits the outpatient clinic to check the function of the IDDS and refill the medication.
Conclusion:
In the case where the IDDS effect suddenly disappears, considering the catheter replacement may be the final option if all troubleshooting steps were failed to prove mechanical defects in the Intrathecal drug delivery system.
References
1. Bardutzky J et al. Intrathecal baclofen for stiff-person syndrome: life-threatening intermittent catheter leakage. Neurology 2003;60:1976-1978.
2. Rhee SM et al. Catheter obstruction of intrathecal drug administration system. Korean J Pain 2012;25(1):47-51.
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