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Marion L. Walker - One of the best experts on this subject based on the ideXlab platform.
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posterior cervical approach for Intrathecal baclofen pump insertion in children with previous spinal fusions technical note
Journal of Neurosurgery, 2005Co-Authors: Marion L. WalkerAbstract:P Intrathecal baclofen pumps for the management of severe spasticity are being used more often in children with cerebral palsy. The Intrathecal catheter is traditionally introduced dorsally in the lumbar region. In some children with previous thoracolumbar fusions for scoliosis, the fusion mass obviates the introduction of the Intrathecal catheter. The authors describe their experience with a posterior cervical approach for Intrathecal baclofen pump insertion in three patients with spastic quadriplegic cerebral palsy who had previously undergone thoracolumbar fusions for scoliosis. Insertion was successful in all three patients; no complications of catheter disconnection, catheter dislodgment, or cerebrospinal fluid leakage occurred. Follow-up review ranged from 10 to 28 months postoperatively (mean 17 months). The posterior cervical approach for Intrathecal baclofen pump insertion is a safe and effective alternative for patients who have previously undergone thoracolumbar spine fusions and in whom the tr...
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posterior cervical approach for Intrathecal baclofen pump insertion in children with previous spinal fusions technical note
Journal of Neurosurgery, 2005Co-Authors: James K Liu, Marion L. WalkerAbstract:Intrathecal baclofen pumps for the management of severe spasticity are being used more often in children with cerebral palsy. The Intrathecal catheter is traditionally introduced dorsally in the lumbar region. In some children with previous thoracolumbar fusions for scoliosis, the fusion mass obviates the introduction of the Intrathecal catheter. The authors describe their experience with a posterior cervical approach for Intrathecal baclofen pump insertion in three patients with spastic quadriplegic cerebral palsy who had previously undergone thoracolumbar fusions for scoliosis. Insertion was successful in all three patients; no complications of catheter disconnection, catheter dislodgment, or cerebrospinal fluid leakage occurred. Follow-up review ranged from 10 to 28 months postoperatively (mean 17 months). The posterior cervical approach for Intrathecal baclofen pump insertion is a safe and effective alternative for patients who have previously undergone thoracolumbar spine fusions and in whom the traditional lumbar approach is not feasible.
James C. Eisenach - One of the best experts on this subject based on the ideXlab platform.
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polyanalgesic consensus conference 2007 recommendations for the management of pain by Intrathecal intraspinal drug delivery report of an interdisciplinary expert panel
Neuromodulation, 2007Co-Authors: Timothy R Deer, James C. Eisenach, Allen W Burton, David Caraway, Elliot S Krames, Samuel J Hassenbusch, Stuart Dupen, Michael A Erdek, Eric Grigsby, Phillip KimAbstract:Background. Expert panels of physicians and nonphysicians in the field of Intrathecal therapies convened in 2000 and 2003 to make recommendations for the rational use of Intrathecal analgesics based on the preclinical and clinical literature known up to those times. An expert panel of physicians convened in 2007 to update previous recommendations and to form guidelines for the rational use of Intrathecal opioid and nonopioid agents. Methods. A review of preclinical and clinical published relevant studies from 2000 to 2006 was undertaken and disseminated to a convened expert panel of physicians and nonphysicians. Focused discussions were held on the rational use of Intrathecal agents and a survey asking questions regarding Intrathecal therapies management was given to the panelists. Results. The panelists, after review of the literature from 2000 to 2006 and discussion, created an updated algorithm for the rational use of Intrathecal opioid and nonopioid agents in patients with nonmalignant and end-of-life pain. Of note is that the panelists felt that ziconotide, based on new and relevant literature and experience, should be updated to a line one Intrathecal drug.
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Intrathecal morphine and ketorolac analgesia after surgery comparison of spontaneous and elicited responses in rats
Pain, 2005Co-Authors: T J Martin, Yong Zhang, Nancy L Buechler, Dawn R Conklin, James C. EisenachAbstract:Pain after surgery results in significant morbidity, and systemic opioids often fail to provide adequate analgesia without marked sedation and respiratory depression. Intrathecal morphine provides better analgesia, but is limited by delayed respiratory depression. Intrathecal injection of the cyclooxygenase inhibitor, ketorolac, has recently entered clinical trials, and the current study examined the interaction between Intrathecal morphine and ketorolac to treat postoperative pain. We also sought to compare these treatments on a commonly used assessment of withdrawal threshold and a new assessment of spontaneous behavior after surgery. Male Sprague Dawley rats and underwent hind paw incision or subcostal laparotomy surgery. Intrathecal morphine, ketorolac, or their combination were injected on the first postoperative day, with outcome measure being return to pre-surgery withdrawal threshold with von Frey filament testing of the paw after paw incision, or return to pre-surgery exploratory activity after laparotomy. Intrathecal morphine completely reversed the effects of surgery in both models, but Intrathecal ketorolac only partially reversed them. Ketorolac enhanced the potency of morphine several fold in both models, and did so synergistically after paw incision. In all cases drug potency was greater for spontaneous than elicited responses. These data confirm that spinal opioid receptor and cyclooxygenase enzyme inhibition diminish elicited tactile hypersensitivity after surgery, and that they similarly return spontaneous behavior to normal. Differences in drug potency could reflect fundamental differences in outcome measures or in the surgical procedures themselves. These data support combination study of Intrathecal morphine and ketorolac for postoperative pain.
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Intrathecal Neostigmine and Sufentanil for Early Labor Analgesia
Anesthesiology, 1999Co-Authors: Kenneth E. Nelson, David D. Hood, Robert D'angelo, Michael L. Foss, Greg C. Meister, James C. EisenachAbstract:BACKGROUND Recent efforts to improve the combined spinal epidural (CSE) technique have focused on adding opioids to other classes of analgesics. In this study, the authors used Intrathecal neostigmine in combination with Intrathecal sufentanil to investigate the usefulness of neostigmine for reducing side effects and prolonging the duration of sufentanil. METHODS One hundred six healthy pregnant women in labor were enrolled in this study, which was divided into four phases. In all phases, patients received a CSE anesthetic while in the lateral position. In phase I, three groups of six women each received Intrathecal neostigmine, 5, 10, or 20 microg, in an open-label, dose-escalating safety assessment. In phase II, 24 women received Intrathecal sufentanil alone to establish an ED50 (dose that produces > 60 min of labor analgesia in 50% of patients). In phase III, an ED50 was established for sufentanil combined with a fixed dose of neostigmine (10 microg). In phase IV, 40 women received either twice the ED50 of sufentanil alone or twice the ED50 of sufentanil plus neostigmine, 10 microg. RESULTS Neostigmine alone had no adverse effects on maternal vital signs, fetal heart rate, or Apgar scores. Neostigmine, 20 microg, produced analgesia in one patient and severe nausea and vomiting in another. The ED50 for Intrathecal sufentanil alone was 4.1 +/- 0.31 microg, and the ED50 for Intrathecal sufentanil combined with neostigmine, 10 microg, was 3.0 +/- 0.28 microg. The duration of analgesia and side effects from double these ED50s (sufentanil, 9 microg, or sufentanil, 6 microg, plus neostigmine, 10 microg) were similar between groups. CONCLUSIONS The 10-microg Intrathecal neostigmine dose alone produced no analgesia or side effects, but reduced the ED50 of Intrathecal sufentanil by approximately 25%. Additionally, doses approximately double these ED50s each produced a similar duration of analgesia and side effects, indicating Intrathecal neostigmine shifts the dose-response curve for Intrathecal sufentanil to the left.
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Intrathecal amitriptyline antinociceptive interactions with intravenous morphine and Intrathecal clonidine neostigmine and carbamylcholine in rats
Anesthesiology, 1995Co-Authors: James C. Eisenach, G F GebhartAbstract:Background : Systemically administered opioids induce analgesia in part by spinal noradrenergic, serotonergic, and cholinergic mechanisms. The current study tested whether antinociception from systemically administered opioids could therefore be enhanced by Intrathecal injection of a monoamine reuptake inhibitor to potentiate the action of spinally released norepinephrine and serotonin (amitriptyline) and Intrathecal injection of a cholinesterase inhibitor to potentiate the action of spinally released acetylcholine (neostigmine). Methods : Rats were prepared with chronic lumbar Intrathecal and femoral intravenous catheters and nociceptive threshold was assessed by hind paw withdrawal to a radiant heat stimulus. An isobolographic design was used to distinguish between additive and synergistic interactions. Results : Intravenous morphine and Intrathecal neostigmine, but not Intrathecal amitriptyline, caused dose-dependent antinociception alone. Combining any two of these three treatments yielded a synergistic interaction compared to each alone, whereas combining all three yielded an additive interaction compared to each two-way interaction. Intrathecal amitriptyline did not affect antinociception from Intrathecal clonidine or Intrathecal carbamylcholine. Conclusions : These data suggest that Intrathecal doses of amitriptyline resulting in potentiation of intravenous morphine antinociception may not be adequate to block muscarinic receptors, because they did not affect carbamylcholine-induced antinociception. These results further support the relevance of spinal monoamine reuptake and cholinesterase inhibition to synergistically enhance analgesia from systemic opioids.
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Postoperative analgesia from Intrathecal neostigmine in sheep.
Anesthesia and analgesia, 1995Co-Authors: Hervé Bouaziz, Chuanyao Tong, James C. EisenachAbstract:Spinal neostigmine produces analgesia in chronically prepared rats, but not in sheep. However, since pain itself activates bulbospinal inhibitory pathways, neostigmine may be more effective in the postoperative period. We examined in sheep the antinociceptive effect of Intrathecal neostigmine in the acute postoperative period and determined the muscarinic receptor subtype activated by neostigmine. A cervical Intrathecal catheter was inserted via a laminotomy in 14 sheep that then received, in random order 1 mg of spinal neostigmine or saline on postoperative Day 1 and the other injection on postoperative Day 2. Three additional sheep received, on separate days, Intrathecal neostigmine alone or with the muscarinic receptor subtype-specific antagonists pirenzepine (M1) 2 mg or AFDX-116 (M2) 2 mg. Antinociception was tested using a mechanical stimulus after each injection. Baseline withdrawal threshold did not change postoperatively. Intrathecal neostigmine, but not saline caused antinociception on both of the first two postoperative days. In contrast, Intrathecal neostigmine caused no antinociception in another similar study performed at least 5 days after surgery. Pirenzepine, but not AFDX-116, abolished antinociception from neostigmine, suggesting an action on M1 subtype muscarinic receptors. Intrathecal neostigmine is antinociceptive in sheep during the acute postoperative period, and these data suggest that spinal cholinergic tone, and hence Intrathecal neostigmine's analgesic effect, may be enhanced during the acute postoperative period.
Claudius Fullhase - One of the best experts on this subject based on the ideXlab platform.
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spinal effects of the fesoterodine metabolite 5 hydroxymethyl tolterodine and or doxazosin in rats with or without partial urethral obstruction
The Journal of Urology, 2010Co-Authors: Claudius Fullhase, Roberto Soler, Christian Gratzke, Marina Brodsky, George J Christ, Karlerik AnderssonAbstract:Purpose: The combination of muscarinic receptor and α1-adrenoceptor antagonists is increasingly used for benign prostatic hyperplasia related lower urinary tract symptoms. In addition to the well established peripheral site of action, little is known about the central effects of muscarinic receptor antagonists and muscarinic receptor/α1-adrenoceptor antagonist combinations on bladder function, partly due to poor brain penetration after systemic administration. We assessed the effects of Intrathecal 5-hydroxymethyl tolterodine, an active metabolite of fesoterodine, in obstructed and nonobstructed rats, and of combined Intrathecal 5-hydroxymethyl tolterodine/doxazosin in a rat model of partial urethral obstruction.Materials and Methods: We used 80 male Sprague-Dawley® rats to test various doses of Intrathecal 5-hydroxymethyl tolterodine and/or Intrathecal doxazosin on urodynamic parameters. Urodynamic evaluation without anesthesia was done 3 days after bladder and Intrathecal catheterization. Two weeks befo...
Timothy R Deer - One of the best experts on this subject based on the ideXlab platform.
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polyanalgesic consensus conference 2012 consensus on diagnosis detection and treatment of catheter tip granulomas inflammatory masses
Neuromodulation, 2012Co-Authors: Timothy R Deer, James P Rathmell, Joshua P Prager, Robert M Levy, Eric Buchser, Allen W Burton, David Caraway, Michael J Cousins, Jose De Andres, Sudhir DiwanAbstract:Introduction: Continuous Intrathecal infusion of drugs to treat chronic pain and spasticity has become a standard part of the algorithm of care. The use of opioids has been associated with noninfectious inflammatory masses at the tip of the Intrathecal catheter, which can result in neurologic complications. Methods: The Polyanalgesic Consensus Conference is a meeting of a group of well-published and experienced practitioners; the purpose of the meeting is to update the standard of care for Intrathecal therapies to reflect current knowledge gleaned from literature and clinical experience. An exhaustive literature search was performed, and information from this search was provided to panel members. Analysis of the published literature was coupled with the clinical experience of panel participants to form recommendations regarding Intrathecal inflammatory masses or granulomas. Results: The panel has made recommendations for the prevention, diagnosis, and management of Intrathecal granulomas. Conclusion: The use of chronic infusions of Intrathecal opioids is associated with the formation of inflammatory masses at the Intrathecal catheter tip in a small minority of treated patients. Nonetheless, the appearance of these space-occupying lesions can lead to devastating neurologic sequelae. The prevention, early detection, and successful treatment of intraspinal granulomas are important considerations when offering Intrathecal drug therapy to patients with chronic intractable pain.
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polyanalgesic consensus conference 2007 recommendations for the management of pain by Intrathecal intraspinal drug delivery report of an interdisciplinary expert panel
Neuromodulation, 2007Co-Authors: Timothy R Deer, James C. Eisenach, Allen W Burton, David Caraway, Elliot S Krames, Samuel J Hassenbusch, Stuart Dupen, Michael A Erdek, Eric Grigsby, Phillip KimAbstract:Background. Expert panels of physicians and nonphysicians in the field of Intrathecal therapies convened in 2000 and 2003 to make recommendations for the rational use of Intrathecal analgesics based on the preclinical and clinical literature known up to those times. An expert panel of physicians convened in 2007 to update previous recommendations and to form guidelines for the rational use of Intrathecal opioid and nonopioid agents. Methods. A review of preclinical and clinical published relevant studies from 2000 to 2006 was undertaken and disseminated to a convened expert panel of physicians and nonphysicians. Focused discussions were held on the rational use of Intrathecal agents and a survey asking questions regarding Intrathecal therapies management was given to the panelists. Results. The panelists, after review of the literature from 2000 to 2006 and discussion, created an updated algorithm for the rational use of Intrathecal opioid and nonopioid agents in patients with nonmalignant and end-of-life pain. Of note is that the panelists felt that ziconotide, based on new and relevant literature and experience, should be updated to a line one Intrathecal drug.
James K Liu - One of the best experts on this subject based on the ideXlab platform.
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posterior cervical approach for Intrathecal baclofen pump insertion in children with previous spinal fusions technical note
Journal of Neurosurgery, 2005Co-Authors: James K Liu, Marion L. WalkerAbstract:Intrathecal baclofen pumps for the management of severe spasticity are being used more often in children with cerebral palsy. The Intrathecal catheter is traditionally introduced dorsally in the lumbar region. In some children with previous thoracolumbar fusions for scoliosis, the fusion mass obviates the introduction of the Intrathecal catheter. The authors describe their experience with a posterior cervical approach for Intrathecal baclofen pump insertion in three patients with spastic quadriplegic cerebral palsy who had previously undergone thoracolumbar fusions for scoliosis. Insertion was successful in all three patients; no complications of catheter disconnection, catheter dislodgment, or cerebrospinal fluid leakage occurred. Follow-up review ranged from 10 to 28 months postoperatively (mean 17 months). The posterior cervical approach for Intrathecal baclofen pump insertion is a safe and effective alternative for patients who have previously undergone thoracolumbar spine fusions and in whom the traditional lumbar approach is not feasible.
