Intrathecal Trialing of Continuous Infusion Combination Therapy With Hydromorphone and Bupivacaine in Failed Back Surgery Patients

Galica, Ryan; Hayek, Salim M.; Veizi, Elias; McEwan, Matthew T.; Katta, Sivakanth; Ali, Omar; Aziz, Nida; Sondhi, Nidhi

doi:10.1111/ner.12737

Cited by 16 publications

(6 citation statements)

References 34 publications

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“… Duse et al, 2009 315 IT morphine in 30 patients with refractory noncancer pain, including 14 who presented with osteoporosis-related back pain, FBBS, or spinal arthrodesis Prospective, I-B IT morphine therapy effectively improved psychosocial function in patients with refractory pain that had failed to respond to standard multimodal therapy. Galica et al, 2018 528 IT hydromorphone and bupivacaine in FBBS (n=54). Retrospective, I-C Combination therapy with IT hydromorphone and bupivacaine improved pain intensity scores in patients with FBSS at 12 and 24 months.…”

Section: Neuromodulationmentioning

confidence: 99%

The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Sayed¹,

Grider²,

Strand³

et al. 2022

JPR

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Introduction Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.

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Section: Neuromodulationmentioning

confidence: 99%

The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Sayed¹,

Grider²,

Strand³

et al. 2022

JPR

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show abstract

“…Fifty‐four intrathecal pump patients with failed back surgery syndrome were followed for 24 months, and the authors reported positive correlation between pre‐trial oral opioid intake and intrathecal hydromorphone dose escalation at 12 ( p = 0.08) and 24 ( p = 0.03) months. Escalation was calculated as the mathematical difference between follow‐up intrathecal dose and starting intrathecal dose (15). A similar, but not statistically significant, positive trend was noted in 35 patients ( p = 0.063) at one year follow‐up (16).…”

Section: Discussionmentioning

confidence: 99%

Association Between Oral Pain Medications and Intrathecal Opioid Dose Escalation: A Retrospective Analysis

Hale

Prayson

Chen

et al. 2020

Neuromodulation: Technology at the Neural Interface

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“…Then, the subcutaneous port was usually placed on the costal margin of the midline of the clavicle on one side, and the catheter was connected to a subcutaneous port via the subcutaneous tunnel. Morphine and bupivacaine diluted with 0.9% sodium chloride solution to 250 mL (Qinghai Pharmaceuticals, Xining, China) were infused into intrathecal space through the subcutaneous port by an external drug infusion pump (ACEMEDICAL Co., Inc., Gyeoggi-Do, Korea) [21,22]. The dosing of intrathecal morphine was based on guidelines and clinical experience.…”

Section: Patient Populationmentioning

confidence: 99%

Intrathecal Analgesia Via a Percutaneous Port For the Management of Movement-Evoked Breakthrough Cancer Pain of Refractory Lower Extremity Cancer Pain: A Retrospective Review and Commentary

Zhou

Guo

2021

Preprint

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Background and Objectives: Intrathecal analgesia (ITA) is a trusty treatment option for refractory and intractable cancer pain. However, there is still no general consensus on the analgesic effect of movement-evoked breakthrough pain (MEBTP) in the ITA setting. This study examined the effect of patient-controlled intrathecal analgesia (PCIA) on analgesic efficacy, emphasizing movement evoked breakthrough pain (MEBTP) in patients with refractory lower extremity cancer pain. Methods: A retrospective chart review included all patients with refractory lower extremity cancer pain who received Intrathecal morphine infusion therapy via percutaneous port (IMITPP) at our hospital between January 2017 and December 2020. Data on the numerical pain rating scales (NRS) scores, opioid doses, and complications were collected from medical records prior to IMITPP and at a one-month postimplant visit.Results: A total of 16 patients were included in the study group. Mean SRPI (spontaneous resting pain intensity) decreased from 8.75 pre- IMITPP to 3.75 post- IMITPP, (P < 0.001); mean MEPI (movement-evoked breakthrough pain intensity) fell from 8.83 pre- IMITPP to 4.25 post- IMITPP (P < 0.001); mean daily morphine equivalent dosing decreased from 360 mg/d to 48mg/d (P< 0.001); mean daily morphine equivalent dosing for MEBTP decreased from 87 mg/d to 6 mg/d (P< 0.001). Both total and breakthrough dosing of conventional opioid medications significantly decreased following the initiation of ITT with PCIA. The mean perceived time to onset with conventional movement evoked breakthrough medications was 38 minutes, and the mean perceived time to onset with PCIA was 8 minutes (P < 0.001). Conclusions: IMITPP was associated with improved pain control in patients with refractory lower extremity cancer pain. Compared with conventional MEBTP medication, appropriate PCIA provided superior analgesia and a much faster onset of action.

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Intrathecal Trialing of Continuous Infusion Combination Therapy With Hydromorphone and Bupivacaine in Failed Back Surgery Patients

Cited by 16 publications

References 34 publications

The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain

Association Between Oral Pain Medications and Intrathecal Opioid Dose Escalation: A Retrospective Analysis

Intrathecal Analgesia Via a Percutaneous Port For the Management of Movement-Evoked Breakthrough Cancer Pain of Refractory Lower Extremity Cancer Pain: A Retrospective Review and Commentary

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