scholarly journals Post Dural Puncture Headache Following Intrathecal Drug Delivery System Placement

2013 ◽  
Vol 2;16 (2;3) ◽  
pp. 101-107 ◽  
Author(s):  
Dr. Stephanie A. Neuman
Keyword(s):  
Drug Delivery ◽  
Drug Delivery System ◽  
Fibrin Glue ◽  
Delivery System ◽  
Dural Puncture ◽  
Surgical Techniques ◽  
Key Words Pain ◽  
Post Dural Puncture Headache ◽  
Intrathecal Drug Delivery ◽  
Blood Patch

Background: Placement of an intrathecal drug delivery system (IDDS) may provide substantial benefit to certain patients. However, placement of these devices is not without complications, and minimal data exist describing the rates of these complications. Specifically, there is a paucity of data describing the incidence of post dural puncture headache (PDPH) following IDDS placement. Objectives: The aim of this study was to identify the incidence and treatment course of PDPH following placement of an IDDS in a retrospective review. Study Design: Retrospective assessment of medical records. Setting: Department of Pain Medicine and Anesthesiology, Mayo Clinic, Rochester, MN. Methods: Following IRB approval, 319 IDDS surgical reports in 285 patients were identified retrospectively over a 20 year study time period. We report demographic information, number of dural punctures, techniques for sealing dural leak, details, and treatment course of PDPH in this population. Results: Symptoms of PDPH were recognized in 73 individual cases (23% of total procedural volume). Younger patient age was the only statistically significant characteristic in predicting development of a PDPH. There were no statistically significant differences found in regards to other risk factors for PDPH development or treatment strategy employed. Seventy-nine percent of PDPH patients were successfully managed with conservative non-interventional therapies (bedrest, IV fluids, analgesics, antiemetics), while 21% required progression to epidural blood or fibrin glue patch procedures for full resolution of symptoms. Limitations: Limitations include the retrospective design of the study as well as the potential for undocumented or improperly documented surgical techniques and/or events. Conclusion: Though the development of PDPH after IDDS implantation was found to be fairly common (23% incidence), the majority of these patients had self-limited symptoms that resolved with conservative medical management. Epidural blood patch or application of epidural fibrin glue was therapeutically successful for the remainder of PDPH patients who were refractory to conservative measures. Key words: Pain, intrathecal drug delivery system, pain pump, morphine, baclofen, postdural puncture headache, spinal headache

scholarly journals Preventing Post Dural Puncture Headache after Intrathecal Drug Delivery System Implantation Through Preventive Fibrin Glue Application: A Retrospective Study

2021 ◽  
pp. E211-E220
Keyword(s):  
Drug Delivery ◽  
Drug Delivery System ◽  
Fibrin Glue ◽  
Delivery System ◽  
Dural Puncture ◽  
Univariate Analysis ◽  
Duration Of Symptoms ◽  
Post Dural Puncture Headache ◽  
Intrathecal Drug Delivery ◽  
Csf Leakage

BACKGROUND: Cerebrospinal fluid (CSF) leakage resulting in post dural puncture headache (PDPH) is a frequent adverse effect observed after intrathecal drug delivery system (IDDS) implantation. CSF leakage symptoms negatively affect patient quality of life and can result in additional complications. Fibrin glue was used to treat CSF leakage syndrome. We developed a procedure to reduce the incidence of PDPH by preventing CSF leakage with the use of fibrin glue during surgery. OBJECTIVES: The main outcome criterion for this study was the incidence of PDPH syndrome after IDDS implantation with or without preventive fibrin glue application during the procedure. STUDY DESIGN: We designed a monocentric retrospective cohort study to compare the incidence of PDPH due to CSF leakage syndrome after lumbar puncture in patients with an implanted intrathecal pump, with or without preventive fibrin glue application during the procedure. SETTING: The study was held in the Anesthesiology and Pain department of the Integrative Cancer Institute (ICO), Angers - France. METHODS: The study compared 2 patient cohorts over 2 successive periods. Fibrin glue was injected into the introducer needle puncture pathway after placement of the catheter immediately following needle removal. RESULTS: The no-glue group included 107 patients, whereas the glue group included 92 patients.Two application failures were observed (2.04%). Fibrin glue application results in a significant decrease in PDPH incidence, from 32.7% in the no-glue group to 10.92 % (P < 0.001) in the glue group. In regard to severity, in the no-glue group, 37.1% of PDPH syndromes were mild, 34.3% were moderate, and 28.6% were severe. In the fibrin glue group, 80% of PDPH syndromes were mild, and 20% were moderate. No severe PDPHs were reported after fibrin glue application. Duration of symptoms was also statistically shorter in the fibrin glue group (maximum of 3 days vs. 15 days in the no-glue group). In a univariate analysis, preventive fibrin glue application and age are significant to prevent PDPH. In multivariate analysis, only fibrin glue application was statistically significant (odds ratio, 0.26; P = 0.0008). No adverse effects linked to fibrin glue were observed. LIMITATIONS: The main limitation of this study is its retrospective nature. In addition, this study is from a single center with a potential selection bias and a center effect. CONCLUSIONS: The novel use of fibrin glue is promising in terms of its effect on PDPH and its safety profile. Its moderate cost and reproducibility make it an affordable and efficient technique. KEY WORDS: Fibrin glue post dural puncture headache, intrathecal therapy, surgical outcome, cancer pain, palliative care, hospice

scholarly journals Lumbar Subarachnoid Hematoma Following an Epidural Blood Patch for Meningeal Puncture Headache Related to the Implantation of an Intrathecal Drug Delivery System

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E405-E411
Author(s):  
Dhanalakshmi Koyyalagunta
Keyword(s):  
Drug Delivery ◽  
Key Words ◽  
Drug Delivery System ◽  
Delivery System ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Post Dural Puncture Headache ◽  
Intrathecal Drug Delivery ◽  
Blood Patch ◽  
Key Words Epidural

Persistent meningeal puncture headache (MPH) is a known complication following both intentional and unintentional puncture of the dura mater. We present a case of persistent MPH following implantation of an intrathecal drug delivery system (IDDS). Two separate epidural blood patches (EBP) were performed under radiographic guidance with contrast visualization of the epidural space on postoperative days 16 and 28, respectively. The case was complicated by the development of a symptomatic lumbar subarachnoid hematoma diagnosed on postoperative day 35. The patient subsequently underwent a laminectomy, evacuation of the hematoma, and explanation of the IDDS. This case illustrates a potential unique morbidity associated with the EBP in a patient with an IDDS. The report concludes with a brief review of MPH followed by a discussion of possible mechanisms underlying this complication. Key words: Epidural blood patch, post dural puncture headache, meningeal puncture headache, complications, spinal subarachnoid hematoma, intrathecal drug delivery, implantable pain therapies, ziconotide, tinnitus, pain, pain procedures

Multiple Fibrin Glue Use in a Complicated Case of Postdural Puncture Headache Following Intrathecal Drug Delivery System Placement: A Case Report

2019 ◽  
pp. 77-81
Author(s):  
Matthew Chung
Keyword(s):  
Drug Delivery ◽  
Cerebrospinal Fluid ◽  
Drug Delivery System ◽  
Fibrin Glue ◽  
Delivery System ◽  
Epidural Blood Patch ◽  
Csf Leak ◽  
Postdural Puncture Headache ◽  
Intrathecal Drug Delivery ◽  
Blood Patch

A postdural puncture headache (PDPH) is a well-described complication after implantation of an intrathecal drug delivery system (IDDS). Treatment is typically with supportive management with the occasional need for an epidural blood patch. We describe a case of a patient with refractory muscle spasticity secondary to cerebral palsy that required a baclofen IDDS implantation and subsequently developed a PDPH. After failing conservative therapy as well as an epidural blood patch, the decision was made to attempt an epidural fibrin patch, which transiently improved her headache. Upon return of the patient’s symptoms, computed tomography myelogram demonstrated an extensive cerebrospinal fluid leak with ventral spread into the retroperitoneal space. Using a novel technique, a second epidural fibrin glue patch was administered just adjacent to the IDDS catheter insertion point, which was then successful in resolving her symptoms. Key words: Intrathecal drug delivery system, postdural puncture headache, dural tear, cerebrospinal fluid (CSF) leak, fibrin glue, epidural blood patch

scholarly journals Treatment of Refractory Postdural Puncture Headache after Intrathecal Drug Delivery System Implantation with Epidural Blood Patch Procedures: A 20-Year Experience

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Markus A. Bendel ◽  
Susan M. Moeschler ◽  
Wenchun Qu ◽  
Eugerie Hanley ◽  
Stephanie A. Neuman ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Drug Delivery System ◽  
Delivery System ◽  
Epidural Blood Patch ◽  
Demographic Data ◽  
Success Rates ◽  
Postdural Puncture Headache ◽  
Invasive Treatment ◽  
Intrathecal Drug Delivery ◽  
Blood Patch

A recent publication reported the incidence of postdural puncture headache (PDPH) in conjunction with intrathecal drug delivery system (IDDS) implantation to be nearly 23 percent. Many patients responded to conservative measures but a percentage needed invasive treatment with an epidural blood patch (EBP). There is limited data to describe the technical details, success rates, and complications associated with EBP in this population. This study aims to provide a retrospective report of EBP for patients suffering from PDPH related to IDDS implantation. A chart review established a cohort of patients that required EBP in relation to a PDPH after IDDS implantation. This cohort was evaluated for demographic data as well as details of the EBP including technical procedural data, success rates, and complications. All patients received a trial of conservative therapy. Standard sterile technique and skin preparation were utilized with no infectious complications. The EBP was placed below the level of the IDDS catheter in 94% of procedures. Fluoroscopy was utilized in each case. The mean EBP volume was 18.6 cc and median time of EBP was day 7 after implant. There were no complications associated with EBP. EBP appears to be an effective intervention in this subset of PDPH patients.

scholarly journals Cerebrospinal Fluid Leak Presenting with Radiculitis and Delayed Onset Headache Following Intrathecal Pump Implantation

2017 ◽  
pp. 89-92
Author(s):  
Laura Anne Lynem
Keyword(s):  
Drug Delivery ◽  
Drug Delivery System ◽  
Delivery System ◽  
Dural Puncture ◽  
Fluid Collection ◽  
Laboratory Evaluation ◽  
Csf Leak ◽  
Access Port ◽  
Lower Back ◽  
Intrathecal Drug Delivery

The issue of cerebrospinal fluid (CSF) leak due to catheter-related failure persists despite new approaches to surgical techniques. There is limited literature about atypical presentations of post dural puncture headaches post intrathecal drug delivery system (IDDS) implantation. A 59-year-old woman with a past medical history of lumbar postlaminectomy syndrome, chronic pain, and lower back pain underwent an intrathecal drug delivery system implantation after exhausting other modalities for pain relief. The patient presented to the office one-month postoperatively with symptoms of lower back pain, left lower extremity radiculopathy, and lower back subcutaneous fluid collection. A dye study using catheter access port access revealed a patent intrathecal catheter with no fluid leakage or collection after injecting contrast dye through the catheter access port. A fine needle aspiration performed under ultrasound guidance revealed a clear fluid. Using laboratory evaluation, this was confirmed to be CSF using laboratory evaluation. An epidural blood patch was performed, which provided minimal radicular pain relief. Several days after, she began experiencing fronto-occipital headaches and the lumbar fluid collection reaccumulated. An intrathecal dye study again was done and showed retrograde flow from the catheter causing a lumbar fluid collection. A catheter exchange was performed resolving the CSF leak and the patient’s symptoms. Post dural puncture headaches after IDDS implantation may have an atypical presentation. Providers should ensure the intrathecal catheter is well secured and firmly anchored to prevent migration. Patient symptoms after IDDS implantation may necessitate further investigation, including: patient evaluation, confirming catheter continuity, and minimally invasive or surgical management. Complications from IDDS may be reduced with further research on equipment and implantation techniques. Key words: Intrathecal drug delivery system, neuraxial analgesia, chronic pain, post dural puncture headache, post laminectomy syndrome, intrathecal catheters

scholarly journals Fibrin glue as a local drug-delivery system for bacteriophage PA5

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Evgenii Rubalskii ◽  
Stefan Ruemke ◽  
Christina Salmoukas ◽  
Andrey Aleshkin ◽  
Svetlana Bochkareva ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Drug Delivery System ◽  
Fibrin Glue ◽  
Delivery System ◽  
Local Drug Delivery ◽  
Local Drug Delivery System
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