What is Intrathecal Pain Pump Implantation

Intrathecal pain pump implantation is surgery to place a pump inside your body. The pump will send pain medicine into your spinal canal through a thin tube (catheter).

The pump is about the size of a hockey puck. It is usually placed under the skin of the abdomen. The catheter will run under your skin from your abdomen to your back. You may need this pump if you have long-term pain that cannot be managed in other ways.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Leaking of spinal fluid (cerebrospinal fluid).
• Blockage, movement, or disconnection of the catheter.
• Failure of the pump.
• A growth that develops around the tip of the pump (granuloma).
• Side effects from your pain medicine.

What happens before the procedure?

• You will need to have a trial injection of pain medicine into your spinal canal. This may include temporary placement of a catheter. This trial will help your health care provider determine if you are a good candidate for the procedure.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Plan to have someone take you home after the procedure.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

Preparation

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You may be given an antibiotic.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).

Placing the Catheter

• You will be rolled onto your side.
• A small incision will be made in your lower back, over your spine.
• A hollow needle will be inserted between the bones of your spine and into the space where your cerebrospinal fluid surrounds your spinal cord (intrathecal space).
• When the needle gets inside the intrathecal space, a catheter will be passed through the needle into the space.
• A type of moving X-ray (fluoroscopy) will be done to check the position of the catheter.
• The needle will be removed.
• The catheter will be secured with a stitch (suture).

Placing the Pump

• You will be moved onto your back.
• An incision will be made where the pump will be placed. A pocket for the pump will be created below your skin and above your abdominal muscles.
• The pump will be inserted.
• A tunneling instrument will be used to make a tunnel beneath your skin from the pump pocket to the incision over your spine.
• The catheter will be placed through the tunnel and attached to the pump.
• Both incisions will be closed with sutures, tape, or staples.
• A bandage (dressing) will be placed over the incisions.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• During your hospital stay, your pump can be programmed, and your medicine can be adjusted. Your health care provider will make sure the pump is working and make sure you are not having a reaction to your medicine, such as breathing difficulty (respiratory depression).
• Do not drive for 24 hours if you received a sedative.

Care After Intrathecal Pain Pump Implantation

These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain in your back and abdomen.
• A slight headache.
• A reaction to your pain medicine that may include itchy skin, drowsiness, and nausea.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to be in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Take your antibiotic medicine as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• Keep the dressing dry until your health care provider says it can be removed.

Driving

• Do not drive for 2 weeks or until your health care provider says it is okay.
• Do not drive or operate heavy machinery while on prescription pain medicine.

Activity

• Limit your movement and activities as told by your health care provider. You may be told to:
  • Avoid sleeping on your belly.
  • Avoid bending or stretching.
  • Avoid raising your arms over your head.
  • Avoid lifting anything that is heavier than 5 lb (2.3 kg).
  • Avoid doing work around the house, such as loading the dishwasher, vacuuming, or mowing the lawn.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Limit alcohol intake to no more than 1 drink per day for nonpregnant women and 2 drinks per day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
• Do not use recreational drugs.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You vomit.
• You have a headache for more than 2 days.
• You feel confused, anxious, dizzy, or depressed.
• You have trouble urinating or having a bowel movement.
• Your pain is not being relieved by the pump.
• You have a fever.
• The alarm on your pump starts to beep.

Get help right away if:

• You have trouble breathing.
• You have a seizure or you pass out.
• You have sudden back pain or weakness in your legs.
• You lose control over urination or bowel movements (have incontinence).