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1311 - Case Series: Novel Challenges with Intrathecal Pump Management

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

PN

Priya C. Nangrani, MD

Brain Injury Medicine Fellow
UT Southwestern
Arlington, Texas, United States

Co-Author(s)

PK

Patricia Krohn, MN, M.P.H., APRN, FNP-BC

Faculty Associate
UT Southwestern
Dallas, Texas, United States
Benjamin N. Nguyen, MD

Professor
UT Southwestern
Dallas, Texas, United States

Case Diagnosis: Intrathecal pump management, increasingly used for pain and spasticity and traditionally managed by physical medicine and rehabilitation specialists, faces emerging challenges as its use grows. This case series explores adverse side effects and outcomes associated with intrathecal pump management in patients at a single center, highlighting new complexities in this treatment approach.

Case Description: The first patient developed severe itching (pruritus) after intrathecal pump placement with Dilaudid, necessitating extended hospitalization, symptomatic treatment, and a reduction of the medication infusion rate. Ultimately, the Dilaudid was replaced with saline. Notably, the patient had previously experienced milder itching during the initial pump trial with Dilaudid. The second patient encountered issues during a new pump refill when a flipped pump impeded proper interrogation. Medication (Baclofen) had been prepared in advance, leading to wastage and a delayed refill.

Discussions: For the first patient, side effects like pruritus during the pump trial phase suggest a need for caution. Adverse effects, even if managed symptomatically, may warrant reconsideration of pump implantation and potential re-trials. Conducting oral medication trials before intrathecal administration could assess tolerability more effectively. Further research is needed to compare reactions to oral versus intrathecal medications. The second patient’s experience underscores the importance of verifying pump positioning and functionality before medication preparation. Coordination with the implanting neurosurgeon to ensure proper pump placement and utilizing abdominal plain film imaging before interrogation can prevent similar issues.

Conclusions: Addressing the nuanced challenges of intrathecal pump treatment is essential. Successful management depends on a collaborative team approach, ensuring both effective implantation and ongoing management. Improved protocols and communication between specialists are vital for enhancing patient outcomes and avoiding future complications.