Intrathecal drug delivery systems

Abstract

Anaesthetists have made use of the intrathecal (IT) space to provide optimum anaesthesia and analgesia for decades. Most commonly to tide the patient through the operative period, but also for postoperative pain relief. The advantages of the techniques and the comparative effectiveness of the drugs compared with other methods of administration are well known. Those of us who work in the field of chronic pain management are faced with providing relative analgesia over days and weeks for terminal cancer patients, months and years for those with progressive cancer-related pain and over decades for those with intractable pain of either malignant or non-malignant aetiology. We can do this to a great extent with the intrathecal drug delivery (ITDD) systems currently available. There are, of course, many treatment options available for patients with chronic pain and ITDD systems are by no means a first-line treatment, but in selected patients both can relieve pain and restore the quality of life in the short and long terms. It should be possible to relieve pain below the diaphragm with relative ease. Above the diaphragm, the effects of drugs on the cardio-vascular system may limit the use of effective doses of drugs. ITDD is an evolving therapy, and current drugs and practice may change in the light of new information.