Intrathecal Catheter Research Articles

Lost in conversion: navigating the challenges of converting intrathecal opioids to oral equivalents-a case report and literature review.

Chronic intrathecal opioid use via intrathecal drug delivery system (IDDS), while effective in some patients, can lead to serious complications and side effects. Complications related to IDDS include mechanical/device malfunction, intrathecal catheter problems, infections, and provider errors. These issues often require urgent surgical intervention, IDDS removal, and abrupt discontinuation of the analgesic infusion. In these scenarios, the safe and effective transition to alternative opioid delivery routes such as intravenous or oral administration is critical. However, an accurate calculation of equianalgesic doses to ensure adequate pain control while minimizing the risk of withdrawal is not well documented. A patient in their 60s with a complex medical history, including chronic low back pain managed with IDDS for 30 years, presented with severe pain unresponsive to dose adjustments. Imaging revealed a catheter-related granuloma at thoracic 8 level, leading to intrathecal therapy discontinuation. A rapid weaning protocol reduced the intrathecal morphine dose by 10% daily, transitioning to systemic opioids based on pain severity and short-acting opioid needs. The final intrathecal-to-oral morphine conversion ratio by the time the pump was empty on day 10 was approximately 1:10. Current guidelines for intrathecal-to-systemic opioid conversion vary widely, with outdated literature suggesting a 1:300 ratio, whereas real-world cases report ratios between 1:2.5 and 1:70. Given this variability, a conservative, patient-specific approach is essential. Clinicians should consider pharmacokinetics, tolerance, and comorbidities, starting with lower conversion ratios and titrating carefully.

Serendipitous discovery of intrathecal catheterization via the lumbosacral plexus in rats: A preliminary study.

Serendipitous discovery of intrathecal catheterization via the lumbosacral plexus in rats: A preliminary study.

Chemical Stability Testing of Solutions for Intraventricular Irrigations via IRRAflow Ventricular Drain System.

Purpose: Advances have been made with delivery of medications via continuous intrathecal irrigating ventricular drains such as IRRAflow (IRRAS). Medications including vancomycin, tobramycin, daptomycin and nicardipine are currently being used as ventricular irrigations via the IRRAflow device. The purpose of this study was to evaluate the chemical stability of minute concentrations of daptomycin, nicardipine, tobramycin, and vancomycin for administration via IRRAflow intrathecal catheters. Methods: Commercially available formulations of daptomycin, nicardipine, tobramycin, and vancomycin were each diluted in separate normal saline (NS) 1000 mL bags to final concentrations of daptomycin 2 mg/1000 mL NS, nicardipine 2.5 mg/1000 mL NS, tobramycin 4 mg/1000 mL NS, and vancomycin 4 mg/1000 mL NS. Samples from each compound were transferred into 2.5 mL glass vials and evaluated in triplicate fashion using ultra-performance liquid chromatography and tandem mass spectrometry (LC-MS/MS). Each injection was analyzed in comparison to its respective calibration curve and a mean result for each time point was determined. The concentration of the samples was tested at 0, 6 and 12-hours for vancomycin, daptomycin, and tobramycin and 0, 4 and 8-hours for nicardipine. All irrigations were kept at room temperature and were not protected from light. Results: All samples tested were found to be chemically stable at various testing time points. Daptomycin retained a mean of 94.3% of initial concentration at 12 hours while tobramycin retained 93.1% of its initial concentration at 12 hours. Vancomycin samples were found to be 92.9% of initial concentration at 12 hours and nicardipine maintained a mean of 90.6% of initial concentration at 8 hours. Future studies could assess these conditions to potentially further stability data. Conclusion: With use of LC-MS, we demonstrated that dilute concentrations of vancomycin, daptomycin, and tobramycin maintain at least 90% of initial concentration for 12 hours at room temperature, whereas nicardipine remained chemically stable for 8 hours at room temperature.

High Cervical Intrathecal Targeted Drug Delivery for Refractory Neuropathic Craniofacial Pain.

High Cervical Intrathecal Targeted Drug Delivery for Refractory Neuropathic Craniofacial Pain.

Investigating the Role of Intrathecal Catheterization After Accidental Dural Puncture in Reducing Post-dural Puncture Headache and Epidural Blood Patch Requirements: A Retrospective Cohort Study

BackgroundAccidental dural puncture (ADP) during epidural catheter insertion in obstetric patients is a well-known complication that often results in post-dural puncture headache (PDPH). Management strategies remain controversial, and the potential benefit of placing an intrathecal catheter (ITC) following ADP is yet to be conclusively established.ObjectivesThe objective of this study is to evaluate whether the placement of an ITC following recognized ADP in parturients reduces the incidence of PDPH and the need for a therapeutic epidural blood patch (EBP).MethodsThis retrospective study analyzed 46 cases of recognized ADP in parturients undergoing labor analgesia. Patients were grouped based on subsequent management: those who received an ITC (n = 32) and those who did not (n = 14). The primary outcomes assessed were the incidence of PDPH and the requirement for EBP. Secondary analysis explored associations with demographic factors, including body mass index (BMI).ResultsPDPH occurred in 66.7% (n = 20) of patients in the ITC group and 71.4% (n = 10) in the non-ITC group (p = 0.433). An EBP was required in 29.0% (n = 9) of ITC cases compared to 35.7% (n = 5) in the non-ITC group (p = 0.594). Although a trend toward reduced EBP requirement was observed in the ITC group, the difference was not statistically significant. A higher BMI appeared to be associated with a reduced risk of PDPH; however, this association did not reach statistical significance.ConclusionITC placement following ADP in parturients was associated with a trend toward reduced EBP requirement, though the difference was not statistically significant. No reduction in PDPH incidence was observed. These findings, while limited by sample size and study design, contribute region-specific real-world data to an evolving area of obstetric anesthesia. Further prospective, multicenter studies are needed to guide definitive recommendations.

Intrathecal catheter after accidental dural puncture in obstetric patients: Safety and effectiveness reducing post-dural puncture headache.

Intrathecal catheter after accidental dural puncture in obstetric patients: Safety and effectiveness reducing post-dural puncture headache.

The Role of microRNAs in Lidocaine-Induced Spinal Cord Neurotoxicity: An Exploration Based on Bioinformatics Analysis.

This study investigated the impact of lidocaine-induced neurotoxicity on microRNA (miRNA) expression in the spinal cord of rats. Sprague-Dawley rats underwent intrathecal catheterization and were randomly assigned to receive either 10% lidocaine or normal saline for three consecutive days. Post-treatment, the paw withdrawal threshold significantly increased, accompanied by notable histopathological changes. Additionally, 470 miRNAs exhibited altered expression following lidocaine treatment, with miR-155-5p, miR-3544, and miR-675-5p showing significant changes. Gene Ontology analysis identified cellular metabolic processes as the most significantly enriched functions. Kyoto encyclopedia of genes and genomes pathway analysis revealed that the enriched signaling pathways are associated with neural injury and neuroprotection, and are involved in regulating cellular metabolism. The Mitogen-Activated Protein Kinase (MAPK) signaling pathway was notably enriched, with Mitogen-activated protein kinase kinase kinase 10 (Map3k10) and Mitogen-activated protein kinase kinase kinase 14 (Map3k14) identified as target genes of miR-155-5p. Following lidocaine treatment, there was an observed increase in the expression of MAP3K10 and MAP3K14 at both the mRNA and protein levels. These results indicate that miR-155-5p, miR-3544, and miR-675-5p might be significantly involved in lidocaine-induced neurotoxicity by influencing cellular metabolism. Furthermore, miR-155-5p/MAPK shows potential therapeutic value for treating lidocaine-induced neurotoxicity.

A Modified Method for Intrathecal Catheterization in Rats.

Intrathecal catheterization has been widely applied in animal experiments, especially those on neuropathic pain. However, the traditional methods still haveseveral limitations. Although some investigators have attempted to improve the traditional methods, the available methods still need to be modified. Herein, we introduce a modified method for intrathecal catheterization in rats. This method uses a 20 cm long stainless-steel wire (0.2 mm in diameter), a 15 cm long plastic PE10 tube, a self-made sealing cap, and a 0.3 cm × 0.5 cm anti-allergic band. Our modified method for intrathecal catheterization has several advantages. First, introducing a stainless-steel wire to PE10 tube increases the elasticity of the tube, improves the success rate of intrathecal catheterization, reduces the amount of space required for the operation, and minimizes the damage to the tissues around the lumbar spine. Second, the length of PE10 tube is determined before the surgery, and catheter indwelling time can be longer than one week. Third, the PE10 tube is fixed by a figure-8 suture, 4 times, which prevents tube movement and retraction when the animal moves. Fourth, aself-made sealing cap is used to seal the PE10 tube, which not only prevents cerebrospinal fluid leakage but also reduces the need for repeated cutting of PE10 tube. Finally, the extracorporeal end of PE10 tube is tied with a band, which prevents tube retraction when the animal moves. This method can increase the catheterization success rate in rats, as approximately 80% of PE10 tubes remained in place even 28 days after surgery. Thus, this modified method may represent a simple, convenient, and reliable approach for repetitive intrathecal drug administration.

Anesthetic Management of Parturients With Achondroplasia During Labor and Delivery: A Narrative Review.

Achondroplasia accounts for approximately 70% of all forms of dwarfism. Cesarean delivery is often required in parturients with achondroplasia due to cephalopelvic disproportion. There is no consensus on the optimal management for cesarean delivery considering the difficulties in both general and regional anesthesia in patients with achondroplasia. The aim of this study was to explore the literature for prior case reports and series to determine the optimum anesthetic management for cesarean delivery in achondroplastic patients. We conducted a review of the literature using Embase, Medline, Scopus, and Web of Science database searches for case series and case reports on achondroplasia and pregnancy through January 2024. Conference abstracts >3 years old were excluded, as well as data on forms of dwarfism other than achondroplasia, patients taller than 147 cm, and non-English language papers. Extracted data included demographic information, anesthetic management, and reported complications. The literature review resulted in 57 manuscripts with a total of 80 anesthetics. Anesthetic management consisted of planned general anesthesia (n = 16), single injection spinal (n = 28), epidural (n = 17), combined spinal-epidural (n = 12), and intrathecal catheter (n = 1). Six patients required conversion from neuraxial anesthesia to general anesthesia due to failed neuraxial placement (n = 3), inadequate blockade (n = 2), and high neuraxial block (n = 1). Reduced dose of intrathecal bupivacaine was common in this population. Complications such as hypotension (4 in 64), inadvertent dural puncture (1 in 64), and transient paresthesia (3 in 64) during neuraxial technique were reported but were infrequent. Neuraxial anesthesia is more common and a viable option in carefully selected parturients with achondroplasia. We recommend reduction of intrathecal local anesthetic as part of a titratable neuraxial technique (ie, combined spinal-epidural) that minimizes the risk of hypotension, high spinal, and emergent intubation.

Cerebrospinal fluid pressure dynamics as a biomechanical marker for quantification of spinal cord compression: Conceptual framework and systematic review of clinical trials.

In patients with acute spinal cord injury (SCI) and degenerative cervical myelopathy (DCM), spinal cord compression is considered a main contributor to spinal cord damage, associated with cerebrospinal fluid (CSF) space obstruction. CSF pressure (CSFP) dynamics are studied as a potential indirect biomechanical marker for spinal cord compression, and as a proxy to estimate spinal cord perfusion pressure (SCPP). Evidence for safety and feasibility of CSFP dynamics in clinical trials as well as interrelations with neuroimaging and intraspinal pressure, and relation to preclinical CSFP models. Systematic review. This review followed PRISMA guidelines, risk of bias assessment with ROBINS-I tool, PROSPERO registration (CRD42024545629). 11 relevant papers were identified (n=212 patients, n=194 intraoperative, n=18 bedside). Risk of bias for safety reporting was low-moderate. Intraoperative CSFP assessments were commonly performed in acute SCI. CSFP was assessed to calculate SCPP (7/11), to evaluate effects from surgical decompression (5/11) and for therapeutic CSF drainage (3/11). The adverse event rate associated with the intrathecal catheter was 8% (n=15/194). The preliminary safety and feasibility profile of CSFP assessments in spinal cord compression encourages clinical application. However, a deeper risk-benefit analysis is limited as the clinical value is not yet determined, given challenges of defining disease specific critical CSFP and SCPP thresholds. The interrelation between measures of CSFP and neuroimaging is yet to be proven. Targeted preclinical studies are essential to improve our understanding of complex CSFP-cord compression interrelations.

The Melatonin Type 2 Receptor Agonist IIK7 Attenuates and Reverses Morphine Tolerance in Neuropathic Pain Rats Through the Suppression of Neuroinflammation in the Spinal Cord.

Morphine analgesic tolerance (MAT) limits the clinical application of morphine in the management of chronic pain. IIK7 is a melatonin type 2 (MT2) receptor agonist known to have antioxidant properties. Oxidative stress is recognized as a critical factor in MAT. This study sought to assess the impact of IIK7 on the progression of MAT and its potential to reverse pre-existing MAT. Wistar rats underwent partial sciatic nerve transection (PSNT) surgery to induce neuropathic pain (NP). Seven days post nerve transection, we implanted an intrathecal (i.t.) catheter and linked it to an osmotic pump. Rats were randomly divided into the following groups: sham-operated/vehicle, PSNT/vehicle, PSNT/IIK7 50 ng/h, PSNT/MOR 15 g/h, and PSNT/MOR 15 g + IIK7 50 ng/h. We implanted two i.t. catheters for drug administration and the evaluation of the efficacy of IIK7 in reversing pre-established MAT. We linked one to an osmotic pump for MOR or saline continuous i.t. infusion. On the 7th day, the osmotic pump was disconnected, and 50 μg of IIK7 or the vehicle was administered through the second catheter. After 3 h, 15 μg of MOR or saline was administered, and the animal behavior tests were performed. We measured the levels of mRNA for Nrf2 and HO-1, pro-inflammatory cytokines (PICs), and the microglial and astrocyte activation in the spinal cord. The co-administration of IIK7 with MOR delayed MAT development in PSNT rats by restoring Nrf2 and HO-1 while also inhibiting the microglial-cell and astrocyte activation, alongside the suppression of PICs. Additionally, a single injection of high-dose 50 μg IIK7 was efficient in restoring MOR's antinociception in MOR-tolerant rats. Our results indicate that the co-infusion of ultra-low-dose IIK7 can delay MAT development and a high dose can reverse pre-existing MAT.

Cosyntropin Prophylaxis With Intrathecal Saline: Impact on Postdural Puncture Headache and Epidural Blood Patch

(Anaesthesia. 2024;79(1):91–92. doi: 10.1111/anae.16139. PMID: 37816309) One of the risks of neuraxial procedures for labor analgesia is accidental dural puncture (ADP), which may lead to further complications including postdural headache (PDPH). The most common treatment for PDPH is an epidural blood patch (EBP); however, this treatment is not infallible. An alternative approach includes the injection of prophylactic intravenous cosyntropin following the dural puncture, which may prevent PDPH or reduce the associated symptoms. Following ADP, anesthetists chose to either select a new site for the epidural or to place an intrathecal (IT) catheter. In this retrospective study, cases where an IT catheter was placed and either administration of intrathecal saline (predelivery) and/or prophylactic intravenous (IV) cosyntropin (postdelivery) occurred were examined to determine the impact on PDPH and EBP.

Activation of MSK-1 exacerbates neuropathic pain through histone H3 phosphorylation in the rats’ dorsal root ganglia and spinal dorsal horn

The exact mechanism underlies the development of neuropathic pain is not yet completely understood. Mitogen and stress-activated kinase 1 (MSK-1) is an important downstream kinase of the mitogen-activated protein kinase (MAPK). It has been extensively studied in the central nervous system, but whether MSK-1 is associated with the neuropathic pain remains elusive. In this experiment, Lumbar 5 spinal nerve ligation (SNL) was used to establish a neuropathic pain condition in the rats. Western blotting, qRT-PCR, immunohistochemistry, intrathecal catheterization and drugs delivery were evaluated to study the physiological responses of the animals. The results showed that SNL resulted in elevated phosphorylated MSK-1 (p-MSK-1) expression in the ipsilateral dorsal root ganglion (DRG) and the spinal dorsal horn in rats, while total MSK-1 (t-MSK-1) did not change significantly. Intrathecal injection of the MSK-1 inhibitor SB747651A partially reversed established neuropathic pain. Additionally, intrathecal administration of MSK-1 siRNA either preoperatively or 7 days postoperatively relieves the development and maintenance of pain, respectively. Meanwhile, the expression levels of p-H3S10, a downstream target of MSK-1, also displayed a significant increase after SNL. And these changes could be reversed by using MSK-1 siRNA. Collectively, the increase of MSK-1 induced by SNL participates in the development and maintenance of neuropathic pain by regulating the expression of p-H3S10 in DRG and spinal dorsal horn. Concentrating on MSK-1 may result in a novel approach to the treatment of neuropathic pain.

Orexin concentrations and diurnal variation in the cerebrospinal fluid of intensive care unit patients undergoing aortic surgery with spinal drainage

BackgroundCerebrospinal fluid (CSF) levels of orexin show a cyclic diurnal variation in healthy subjects, which is diminished in patients with certain diseases. However, possible circadian variations in orexin levels in critically ill patients remain unknown. In this study, we evaluated the orexin concentrations in the CSF and their diurnal variation in patients undergoing thoracic aortic aneurysm repair with lumbar intrathecal catheterization for CSF drainage after non‐neurosurgery.MethodsEligible patients with a lumbar intrathecal catheter placed for CSF drainage following aortic surgery at a single‐center ICU between September 2019 and February 2020 were included. Catheters were placed before anesthesia induction, and CSF was collected at the time of catheter placement, ICU admission, and daily at 6:00, 12:00, 18:00, and 24:00 until the catheter was removed or for up to 5 days after admission to the ICU.ResultsThree patients (Patients A, B, and C) who underwent thoracic aortic aneurysm repair were included. Patients B and C received sedatives or hypnotics during the orexin measurement period. The baseline orexin levels for Patients A, B, and C were 219.9, 312.3, and 403.8 pg/mL, while the mean orexin levels were 319.4 ± 82.6, 372.4 ± 56.0, and 306.3 ± 48.3 pg/mL, respectively. For all three patients, orexin levels showed diurnal variations, but no consistent periodic changes.ConclusionCSF orexin concentrations for patients undergoing thoracic aortic aneurysm repair in the ICU were within the reported range compared to those of previously reported healthy subjects; however, consistent periodic diurnal variations were not observed.

ID: 331325 Review of Intrathecal Inflammatory Mass and Catheter Adhesion in Patients with Intrathecal Drug Delivery Systems

ID: 331325 Review of Intrathecal Inflammatory Mass and Catheter Adhesion in Patients with Intrathecal Drug Delivery Systems

ID: 335796 Comparison of Outcomes Before and After Attention to Intraoperative Placement of Intrathecal Catheter Tip

ID: 335796 Comparison of Outcomes Before and After Attention to Intraoperative Placement of Intrathecal Catheter Tip

Intrathecal pain pump causing delayed acute flaccid paralysis: A case report and review of the literature.

Patients with intrathecal catheters for pain medication infusion should be aware of the possible complication of acute flaccid paralysis. While exceedingly rare, it should prompt immediate medical attention to rule out compressive pathology requiring intervention.

ID: 335248 Diagnosis and Management of an Intrathecal Catheter Embedded in the Cervical Spinal Cord

ID: 335248 Diagnosis and Management of an Intrathecal Catheter Embedded in the Cervical Spinal Cord

Complications of intrathecal baclofen therapy in children and young adults.

The primary objective of this study was to determine the frequency and nature of complications that occur during intrathecal baclofen (ITB) therapy, including nonsurgical complications as well as complications associated with both implantation surgeries and subsequent revisions. The authors retrospectively reviewed the medical records of all patients who had baclofen pumps implanted at a tertiary children's hospital from 2006 through June 2019. The study employed appropriate descriptive statistics and statistical models to analyze patient demographics, improvements in tone, and clinical complications. The authors evaluated the associations of complications as well as changes in modified Ashworth Scale (MAS) scores with various preexisting conditions (e.g., presence of gastrostomy tubes [G-tubes] and ventriculoperitoneal [VP] shunts) and surgical variations (e.g., use of newer [Ascenda] catheters and subfascial versus subcutaneous catheter tunneling). One hundred forty-two pumps were implanted. Complications occurred in 111 patients (78.2%). The most frequent complications were catheter complications and pseudomeningoceles, each of which occurred in 63 (44%) patients. On multivariable analysis, pseudomeningoceles and percutaneous CSF leaks were significantly less likely when intrathecal catheters were placed via laminotomy versus spinal needle (OR 4.6, p = 0.044), and when catheters were passed from the posterior incision to the abdominal pump pocket deep to the thoracolumbar fascia rather than superficial to it (OR 2.7, p = 0.008). Preexisting G-tubes and VP shunts at the time of pump implantation were not associated with a significantly increased likelihood of pump malfunction or infection. Ascenda catheters were significantly less likely to have disconnections (p < 0.001) and obstructions (p = 0.016), and overall were less likely to have any catheter-related complications (p = 0.01). Patients with preexisting VP shunts at the time of implantation had a significantly greater mean decrease in MAS scores in both their lower extremities (1.8, p = 0.003) and upper extremities (1.3, p = 0.002) than did patients without shunts. Various complications are associated with ITB therapy, most commonly catheter complications and pseudomeningoceles. There have been fewer catheter complications associated with the newest catheter model, while pseudomeningoceles have become less frequent since the surgical technique was modified to prevent them. VP shunts and G-tubes are not associated with significantly higher complication rates and shunts seem to be associated with greater efficacy of ITB therapy, as represented by a greater mean improvement in MAS scores.

Magnetically Guided Microcatheter for Targeted Injection of Magnetic Particle Swarms.

The initial delivery of small-scale magnetic devices such as microrobots is a key, but often overlooked, aspect for their use in clinical applications. The deployment of these devices within the dynamic environment of the human body presents significant challenges due to their dispersion caused by circulatory flows. Here, a method is introduced to effectively deliver a swarm of magnetic nanoparticles in fluidic flows. This approach integrates a magnetically navigated robotic microcatheter equipped with a reservoir for storing the magnetic nanoparticles. The microfluidic flow within the reservoir facilitates the injection of magnetic nanoparticles into the fluid stream, and a magnetic field gradient guides the swarm through the oscillatory flow to a target site. The microcatheter and reservoir are engineered to enable magnetic steering and injection of the magnetic nanoparticles. To demonstrate this approach, experiments are conducted utilizing a spinal cord phantom simulating intrathecal catheter delivery for applications in the central nervous system. These results demonstrate that the proposed microcatheter successfully concentrates nanoparticles near the desired location through the precise manipulation of magnetic field gradients, offering a promising solution for the controlled deployment of untethered magnetic micro-/nanodevices within the complex physiological circulatory systems of the human body.