Introduction
Screening Test
Preoperative Considerations and Care
Programmable Infusion System Implant Procedure
Postoperative Care

Training for key personnel should be conducted and arrangements for Therapy Maintenance should be made before a drug delivery system is implanted. (Also see Practice Components for other considerations.) In addition, patients being considered for intrathecal drug delivery should meet specific patient selection criteria. When an appropriate patient is identified, implantation of a drug infusion system generally involves two stages. The first stage is a screening test of intraspinal morphine. If the patient receives adequate relief, the second stage is to implant the infusion system.

Screening Test

The screening test is performed by administering intraspinal morphine via a lumbar puncture or percutaneous catheter, either by bolus injection or continuous infusion. Some clinicians deliver the drug into the epidural space, while others prefer intrathecal delivery. The most common screening test methods are bolus intrathecal/epidural injection and continuous intrathecal/epidural delivery.

During the screening, the clinician evaluates the patient's response to therapy by assessing pain relief and activity levels. If the patient reports at least a 50% reduction in pain with tolerable adverse effects, it is considered a positive response^1,2 and the patient and physician may decide to proceed with implantation of a drug delivery system. (See Pain Assessment Strategies for more information on pain assessment techniques.)

System Implantation

There are a number of tasks that need to be completed in preparation for the implant procedure. Some of the major pre-operative responsibilities include obtaining informed consent, identifying and controlling infections, marking the pump pocket site, and proper patient positioning and draping. The surgical implant procedure generally takes 1 to 2 hours. Implantation of the catheter and pump is usually done under general anesthesia, but can be done under local or spinal anesthesia with monitored anesthesia care if the physician desires or the patient's condition warrants

²Krames ES: Intraspinal opioid therapy for chronic nonmalignant pain: Current practice and clinical guidelines. J Pain Symptom Manage.1996 Jun;11(6):333-52. Review.

Introduction
Screening Test
Preoperative Considerations and Care
Programmable Infusion System Implant Procedure
Postoperative Care