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At least 1,027 records · Page 57Linked to original sources
PubMed1999

Long-term intraspinal infusions of opioids with a new implantable medication pump.

Experiences with long-term intraspinal infusion of opioid drugs using the new implantable medication pump VIP 30 in patients with chronic non-malignant pain are reported. During a 19-month period 10 patients with chronic pain--mainly mixed nociceptive-neuropathic pain--underwent implantation of the medication pump for long-term treatment. The mean follow-up period was 9.5 months. Pain relief was classified as very good in 22.2%, good in 44.4%, moderate in 22.2% and poor in 11.1%. In 88.9% of the cases the patients stated they would undergo the same procedure again. Technical problems (catheter dislocation) developed in 1/10 patients could be surgically corrected. One pump including catheter was explanted because of an infected seroma within the pocket area. Long-term intrathecal application of opioids with the VIP 30 pumps is an effective and safe treatment in patients with chronic non-malignant pain.

Adult↗
PubMedDate not supplied

[Intrathecal interferon therapy in chronic echovirus meningoencephalitis in Bruton type agammaglobulinemia].

A 9-year-old body with X-linked agammaglobulinemia developed chronic enteroviral meningoencephalitis (CEMA) caused by echovirus type 6. Intravenous treatment with selected immunoglobulin charges containing high titers against echovirus type 6 or combination with beta-interferon did not result in improvement. After implantation of a Rickham reservoir and periodical administration of intraventricular and intravenous immunoglobulin the virus recurred rapidly each time treatment was stopped. After 20 months of treatment the patient received a combined therapy with beta-interferon and selected immunoglobulin. Both drugs were given by lumbar puncture, intravenously and via Rickham reservoir. Subsequently echovirus type 6 could not be isolated in culture or PCR. Cerebrospinal fluid pleocytosis disappeared. The remission is lasting for more than three years. Intrathecal and intraventricular beta-interferon therapy for CEMA is being reported for the first time. Facing the unfavourable prognosis of the disease this mode of treatment is a new therapeutic approach following failure of other therapies.

Agammaglobulinemia↗
PubMedDate not supplied

GMFM 1 year after continuous intrathecal baclofen infusion.

The purpose of this study was to assess whether there is an improvement in motor function in persons with cerebral palsy (CP) who have had a reduction of muscle tone by continuous intrathecal baclofen infusion. This was a prospective, open label, non-blinded case series without a control group, conducted at multiple centres. There were 31 subjects, aged 4-29 years. All had a pre-treatment mean lower extremity Ashworth scores of >or= 3 and a significant reduction in tone after a bolus injection of intrathecal baclofen (ITB) and received an implanted pump for continuous delivery of ITB. Motor function was assessed by the Gross Motor Function Measure (GMFM) prior to and 1 year following pump implantation. Significant improvement (p < 0.05) in mean GMFM scores was seen in subjects < 8 years (mean change 4.1) and in those from 8-18 years (mean change 3.7) and in subjects with CP Classes 2 and 5 (mean changes 6.2 and 2.9). There was a statistically significant decrease (p < 0.05) in Ashworth scores in CP classes 2-5. Subjects or their caregivers that completed a survey about perceived changes stated that motor control, positioning and endurance improved.

Adolescent↗
PubMedDate not supplied

Satisfaction of individuals treated long-term with continuous infusion of intrathecal baclofen by implanted programmable pump.

PURPOSE: To investigate the perspective of the individual receiving intrathecal baclofen (ITB) or his/her caregiver concerning its effects and to describe characteristics of those that were satisfied or not satisfied. METHODS: After IRB approval, potential subjects were identified who had undergone ITB pump implantation at least 1 year prior to the study. One hundred subjects/caregivers were interviewed by phone. Interview consisted of a scripted questionnaire to obtain subject/caregiver opinions about changes in function and caregiver assistance, as well as satisfaction with ITB. Medical records were reviewed to collect information including diagnosis, ITB related surgeries and medications. RESULTS: Subjects ranged in age from 5-42 years and 88 had a diagnosis of cerebral palsy. Improvement was noted in the following areas: positioning 69%, transfers 58%, dressing 69% and toileting/hygiene 51%. Fifty-four per cent reported reduction in startle movements. Sleep was improved in 43% and comfort in 53%. Twenty-two subjects experienced 32 events related to the ITB hardware or surgery. Only 12% indicated they would not choose to undergo the procedure again. DISCUSSION: Generally, subjects and their caregivers were satisfied with the results after ITB pump implantation. A majority reported improvements in positioning, transfers, dressing, toileting/hygiene and comfort.

Adolescent↗
PubMed2003

A prospective, randomized, placebo-controlled evaluation of corticoneuronal response to intrathecal BDNF therapy in ALS using magnetic resonance spectroscopy: feasibility and results.

During the multicenter, phase III trial of intrathecal BDNF in ALS, we evaluated the neuronal marker N-acetylaspartate (NAA) as a surrogate marker of therapeutic efficacy using proton magnetic resonance spectroscopic imaging (MRSI) in a prospective and blinded manner. Selected subjects tolerated the study well without pump malfunction. The NAA to creatine (Cr) intensity ratio (NAA/Cr) was measured in the precentral and postcentral gyri, the superior parietal lobule, the supplementary motor area, and the premotor cortex. After 4.5+/-0.6 weeks treatment, NAA/Cr did not change significantly in any of the regions in the BDNF-treated group (n=5) compared to the placebo group (n=6). The lack of change in NAA correlated with the lack of clinical efficacy and supports the validity of NAA/Cr as a surrogate in this setting. MRSI is a feasible and safe method to evaluate intrathecal therapies in ALS.

Adult↗
PubMed2004

Interventional procedures for cancer pain management: when are they indicated?

Non-invasive pharmacological management of patients with cancer related pain has resulted in pain control in 90-95% of the patients. Thus, 5-10% of patients still experience inadequate pain control despite aggressive combined pharmacological therapy. Moreover, patients may not tolerate an aggressive program of titration of medications and fail this approach because of side effects. In these patients interventional techniques have been very useful. This article discusses the alternative therapies, as well as the pitfalls in implementing these therapies, to achieve the highest possible success while minimizing potential complications and side effects.

Analgesics↗
PubMed1982

Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden.

The Swedish Society of Anaesthetists conducted a nationwide retrospective survey of clinical experience with extradural and intrathecal opiates. Special interest was focused on the frequency and type of ventilatory depression. The questionnaire was answered by 84 of 93 departments (90%). Up to May 1981 extradural morphine had been given to approximately 6000-9150 patients, extradural pethidine to 220-450 and intrathecal morphine to 90-150 patients. Ventilatory depression requiring treatment with naloxone was reported in 23 patients treated with extradural morphine (0.25-0.40%) and in six given intrathecal morphine (4-7%). In 22 patients the administration of extradural morphine was considered as a major contributory factor for the occurrence of ventilatory depression. Only two of these 22 patients experienced ventilatory depression later than 6 h after the last dose of opiates (S.C., i.m., i.v. or extradural). Patients aged 70 yr or more, those receiving thoracic extradural puncture and those with reduced ventilatory capacity seemed to be overrepresented.

Adult↗
PubMed1990

Differential cross-tolerance between intrathecal morphine and sufentanil in the rat.

By means of a subcutaneously implanted osmotic pump, groups of rats received a constant-rate (1 microliter/h), 7-day intrathecal infusion of saline or one of two mu opioid agonists: sufentanil (0.6 nmol/h) or morphine (20 nmol/h). These concentrations of morphine and sufentanil yielded a comparable near maximal hot-plate response latency on day 1 of the infusion. On day 7, the magnitude of tolerance was assessed in each group by establishing intrathecal dose-response curves and ED50 values for sufentanil and morphine given as a bolus injection. Each infused animal was used for a single bolus injection. In all cases, infusion with the opioid resulted in a rightward shift (increase in ED50) for both morphine and sufentanil as compared to saline-infused animals. The magnitude of the shift, however, was different for the two drugs. Thus in morphine-infused rats, the morphine ED50 increased as compared to saline-infused animals by a factor of 44, whereas the sufentanil ED50 shifted by a factor of 10. In sufentanil-infused animals, the respective shifts in the morphine and sufentanil ED50 values were increased by a factor of 9 and 3, respectively. Thus, a significantly greater shift as compared to saline-infused animals was observed in morphine-infused than in sufentanil-infused animals. Conversely, regardless of the opioid to which the animal was exposed, morphine-tested animals showed a greater rightward shift than did sufentanil-tested animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesics, Opioid↗
PubMed2002

Randomized controlled trial comparing traditional with two "mobile" epidural techniques: anesthetic and analgesic efficacy.

BACKGROUND: The authors recently showed that "mobile" epidural analgesia, using low-dose local anesthetic-opioid mixtures, reduces the impact of epidural analgesia on instrumental vaginal delivery, relative to a traditional technique. The main prespecified assessment of pain relief efficacy, women's postpartum estimates of labor pain after epidural insertion, did not differ. The detailed analgesic efficacy and the anesthetic characteristics of the techniques are reported here. METHODS: A total of 1,054 nulliparous women were randomized, in labor, to receive boluses of 10 ml 0.25% bupivacaine (traditional), combined spinal-epidural (CSE) analgesia, or low-dose infusion (LDI), the latter groups utilizing 0.1% bupivacaine with 2 microg/ml fentanyl. Visual analog scale pain assessments were collected throughout labor and delivery and 24 h later. Details of the conduct of epidural analgesia, drug utilization, and requirement for anesthesiologist reattendance were recorded. RESULTS: A total of 353 women were randomized to receive traditional epidural analgesia, 351 received CSE, and 350 received LDI. CSE was associated with a more rapid onset of analgesia, lower median visual analog scale pain scores than traditional in the first hour after epidural insertion, and a significant reduction in bupivacaine dose given during labor. Pain scores reported by women receiving LDI were similar to those in the traditional group throughout labor and delivery. Anesthesiologist reattendance was low but greater with each mobile technique. CONCLUSIONS: Relative to traditional epidural analgesia, LDI is at least as effective and CSE provided better pain relief in the early stages after insertion. The proven efficacy of mobile epidurals and their beneficial impact on delivery mode make them the preferred techniques for epidural pain relief in labor.

Adult↗
PubMed2001

Intrathecal baclofen for spasticity caused by thrombotic stroke.

This study was undertaken to determine the efficacy of intrathecal baclofen therapy in patients who suffer spasticity after a stroke. This case involves a 64-yr-old woman whose thrombotic strokes resulted in severe left-upper and lower-limb spasticity. The patient achieved substantial functional gains as well as improved ease of care, quality of life, and cessation of narcotic use.

Baclofen↗