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What is an Intrathecal (IT) Catheter and Pump implantation?
Even when managed according to guidelines, approximately 14% of cancer patients have unrelieved pain or unacceptable side effects, and there is good evidence that patients still are not receiving optimal therapy.
For a pain medication to be effective, it needs to reach an appropriate level in the bloodstream and then in the central nervous system (spinal cord and brain). Medication can be administered through the skin (e.g., Fentanyl patch), orally, intravenously, or directly into the central nervous system. Direct administration into the central nervous system allows for achieving high efficacy with low doses, minimizing or avoiding drug distribution to other parts of the body. This means that side effects are significantly reduced while pain relief is substantial. Implantable drug delivery systems or also called intrathecal catehters and pumps administer small amounts of drugs directly to the spinal cord and reduce systemic medication exposure by a factor of 300 to one 2.
During the implantation of an intrathecal catheter, a very thin (1mm), soft catheter is inserted next to the spinal cord, targeting the area where spinal anesthesia is performed for surgeries. The catheter eventually remains under the skin, connected to a medication delivery pump. The pump can be implanted subcutaneously or can remain external. The medication delivery pump needs to be refilled approximately once a month.
In which diseases/conditions is the procedure used?
This procedure is primarily used for managing cancer-related pain conditions. In other centers, it is also used for the treatment of cerebral palsy and spasticity.
When are the contraindications of the IT catheter and pump implantation?
The procedure is not applicable in cases of infection, as it may exacerbate the infection.
What to expect during the intervention?
The intervention takes approximately 60-90 minutes and is performed under sedation. It is always carried out in an operating room, under sterile conditions, and sometimes guided by X-ray. No incisions are made on the patient’s skin; only needles are used.
What happens after the implantation of the Intrathecal Catheter and Pump?
Following the implantation, the treating physician initiates treatment based on the patient’s previous pain relief dosage; partly new medications may be introduced instead of the previous ones. Subsequently, the machine administers the pain reliever, and the patient can supplement themselves with extra doses for breakthrough pain relief. This is called Patient Controlled Anesthesia (PCA). For those with an external pump, a small catheter is led under the skin to the pump. This point is sterilely dressed on the skin, but the area should not be exposed to water despite the dressing.
How long does the catheter stay in place?
The catheter implanted with a pump can remain in place for a long time, even for many years. When using an external pump, only the catheter is inside the body. With proper hygiene, it can remain in place for months, whether it signifies recovery or end of life.
Does the IT catheter and pump hinder further examinations (MRI, CT)?
New morphine pumps are MRI-compatible, so they do not hinder MRI or CT examinations. An exception is the area directly adjacent to the pump, as it may impair image quality.
The catheter with an external pump does not hinder examinations in any way, as the pump can be disconnected from the catheter during the examination.
Does the IT catheter and pump hinder further treatment for the patient?
No. Chemotherapy/immunotherapy/radiation therapy can continue as usual. The progression or cessation of the underlying disease is independent of the IT pump use.
How does the implantation of the IT pump affect survival?
Numerous studies confirm that adequate pain relief not only enhances quality of life but also improves survival.1,2 The patient’s appetite improves, constipation is less likely to develop, weight loss is reduced, and the patient remains more mobile, all of which contribute to improved survival. Naturally, the implantation of the IT pump is only justified for those for whom medication or less invasive treatments are insufficient or side effects are intolerable.
How should the patient prepare for the intervention?
What are the possible risks and side effects of Intrathecal Catheter and Pump implantation?
With proper medication adjustments, side effects can be minimized, but nausea, vomiting, constipation, urinary retention, itching, and confusion may still occur. Extremely rare side effects may include infection, pain, headache, limb weakness, and paralysis.
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