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A new approach using high volume blood patch for prevention of post-dural puncture headache following intrathecal catheter pump exchange.

Abdulla S, Vielhaber S, Heinze HJ, Abdulla W - Int J Crit Illn Inj Sci (2015 Apr-Jun)

Bottom Line: Twenty-one patients were successfully treated with prophylactic EBP, while one patient could not be properly evaluated because of intracranial bleeding as the underlying disease.A new approach using a high-volume prophylactic EBP for preventing PDPH following catheter exchange is presented.The efficacy and safety of this technique for 1 year follow-up have been evaluated and was found to be safe and potentially effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany ; German Center for Neurodegenerative Diseases, Magdeburg, Germany.

ABSTRACT

Background: In an observational study, complications of intrathecal catheter pumps necessitating surgical exchange were analyzed. Also the use of a high-volume prophylactic epidural blood patch (EBP) during surgery for preventing post-dural puncture headache (PDPH) with a follow-up for 1 year is described.

Materials and methods: In 22 patients with refractory chronic pain of cancer/noncancer origin or severe spasticity, who were receiving intrathecal morphine including adjuvants or baclofen for symptom relief, catheter exchange with or without pump was performed. In patients with documented symptoms of PDPH following initial intrathecal catheter implantation, a prophylactic EBP with a high blood volume was used for PDPH prevention during surgery. Catheters were replaced using 40 mL EBP before entering dural space at a speed of 5mL/min into the epidural space. Patients were asked to quantify pain experience and functional ability.

Results: From a sample of 72 patients admitted for catheter exchange with or without pump, 22 patients (33%) (12 male, 10 female) had a history of PDPH following initial implantation. Diagnostic and therapeutic measures occurring with malfunction of intrathecal catheter pump systems were described. Twenty-one patients were successfully treated with prophylactic EBP, while one patient could not be properly evaluated because of intracranial bleeding as the underlying disease.

Conclusions: A new approach using a high-volume prophylactic EBP for preventing PDPH following catheter exchange is presented. The efficacy and safety of this technique for 1 year follow-up have been evaluated and was found to be safe and potentially effective.

No MeSH data available.


Related in: MedlinePlus

Catheter (a) obstruction and (b) fracture by fibrous sheath
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Figure 3: Catheter (a) obstruction and (b) fracture by fibrous sheath

Mentions: Substantial complications prior or during surgery for each patient, that is relevant to discuss, were recorded. Based on a distinct increase of predominantly excitatory symptoms (hyperexcitability or increased muscle spasticity) due to reduced drug infusion suggesting pump malfunctioning and/or catheter defect, the preoperative check program was started. In six patients, the battery-powered pump had neared the manufacturer's recommended exchange interval; thus the device was electively scheduled for replacement which was necessary after 5.7 ± 0.3 years. In two cases, the pumps were defective. One pump was battery-powered, while the other was gas driven. In both cases, withdrawal symptoms appeared within 1–3 days after interruption of intrathecal therapy. One patient treated with baclofen using a battery-powered pump for muscle spasticity on upper and predominantly lower extremities presented with more stiffness which completely disappeared after two boluses of 25 μg (maximum 50 μg) into the side port. The other patient treated with morphine showed withdrawal symptoms, such as stomach cramps, diarrhea, rhinorrhea, sweating, elevated heart rate and increased blood pressure, irritability, hyperalgesia, and insomnia. The symptoms also disappeared completely after the injection of 1–2 mg morphine diluted in 5 mL normal saline within 15 min into the side port. The malfunctioning pumps were also explanted and replaced. Catheter complications were the most common cause of malfunctioning in our patients. While the catheters were checked with fluoroscopy, we found slight leaking at different sites in the catheter system [Figure 2a and b]. During surgical exploration at the site of spinal entry, we observed catheter obstruction and fracture caused by fibrous sheath [Figure 3a and b]. The catheter was fractured close to the site of spinal entry [Figure 3b]. Catheter obstruction was confirmed in four cases by lack of CSF aspiration with the needle inserted into the side port bypassing the pump. Normal saline was also unable to enter the port. In seven cases, leakage of CSF with perforating tear was found in close proximity to the vertebral spinous process and spine catheter entry site.


A new approach using high volume blood patch for prevention of post-dural puncture headache following intrathecal catheter pump exchange.

Abdulla S, Vielhaber S, Heinze HJ, Abdulla W - Int J Crit Illn Inj Sci (2015 Apr-Jun)

Catheter (a) obstruction and (b) fracture by fibrous sheath
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4477403&req=5

Figure 3: Catheter (a) obstruction and (b) fracture by fibrous sheath
Mentions: Substantial complications prior or during surgery for each patient, that is relevant to discuss, were recorded. Based on a distinct increase of predominantly excitatory symptoms (hyperexcitability or increased muscle spasticity) due to reduced drug infusion suggesting pump malfunctioning and/or catheter defect, the preoperative check program was started. In six patients, the battery-powered pump had neared the manufacturer's recommended exchange interval; thus the device was electively scheduled for replacement which was necessary after 5.7 ± 0.3 years. In two cases, the pumps were defective. One pump was battery-powered, while the other was gas driven. In both cases, withdrawal symptoms appeared within 1–3 days after interruption of intrathecal therapy. One patient treated with baclofen using a battery-powered pump for muscle spasticity on upper and predominantly lower extremities presented with more stiffness which completely disappeared after two boluses of 25 μg (maximum 50 μg) into the side port. The other patient treated with morphine showed withdrawal symptoms, such as stomach cramps, diarrhea, rhinorrhea, sweating, elevated heart rate and increased blood pressure, irritability, hyperalgesia, and insomnia. The symptoms also disappeared completely after the injection of 1–2 mg morphine diluted in 5 mL normal saline within 15 min into the side port. The malfunctioning pumps were also explanted and replaced. Catheter complications were the most common cause of malfunctioning in our patients. While the catheters were checked with fluoroscopy, we found slight leaking at different sites in the catheter system [Figure 2a and b]. During surgical exploration at the site of spinal entry, we observed catheter obstruction and fracture caused by fibrous sheath [Figure 3a and b]. The catheter was fractured close to the site of spinal entry [Figure 3b]. Catheter obstruction was confirmed in four cases by lack of CSF aspiration with the needle inserted into the side port bypassing the pump. Normal saline was also unable to enter the port. In seven cases, leakage of CSF with perforating tear was found in close proximity to the vertebral spinous process and spine catheter entry site.

Bottom Line: Twenty-one patients were successfully treated with prophylactic EBP, while one patient could not be properly evaluated because of intracranial bleeding as the underlying disease.A new approach using a high-volume prophylactic EBP for preventing PDPH following catheter exchange is presented.The efficacy and safety of this technique for 1 year follow-up have been evaluated and was found to be safe and potentially effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany ; German Center for Neurodegenerative Diseases, Magdeburg, Germany.

ABSTRACT

Background: In an observational study, complications of intrathecal catheter pumps necessitating surgical exchange were analyzed. Also the use of a high-volume prophylactic epidural blood patch (EBP) during surgery for preventing post-dural puncture headache (PDPH) with a follow-up for 1 year is described.

Materials and methods: In 22 patients with refractory chronic pain of cancer/noncancer origin or severe spasticity, who were receiving intrathecal morphine including adjuvants or baclofen for symptom relief, catheter exchange with or without pump was performed. In patients with documented symptoms of PDPH following initial intrathecal catheter implantation, a prophylactic EBP with a high blood volume was used for PDPH prevention during surgery. Catheters were replaced using 40 mL EBP before entering dural space at a speed of 5mL/min into the epidural space. Patients were asked to quantify pain experience and functional ability.

Results: From a sample of 72 patients admitted for catheter exchange with or without pump, 22 patients (33%) (12 male, 10 female) had a history of PDPH following initial implantation. Diagnostic and therapeutic measures occurring with malfunction of intrathecal catheter pump systems were described. Twenty-one patients were successfully treated with prophylactic EBP, while one patient could not be properly evaluated because of intracranial bleeding as the underlying disease.

Conclusions: A new approach using a high-volume prophylactic EBP for preventing PDPH following catheter exchange is presented. The efficacy and safety of this technique for 1 year follow-up have been evaluated and was found to be safe and potentially effective.

No MeSH data available.


Related in: MedlinePlus