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Intrathecal Drug Delivery

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https://www.readbyqxmd.com/read/28890435/pain-control-in-thoracic-oncology
#1
Christine Peeters-Asdourian, Gilbert Massard, Paragi H Rana, Paul Van Houtte, Andrew P White, Bogdan Grigoriu, Dominique Lossignol, Mohammed Almalki, Jean Alexiou, Jean-Luc Engelholm, Jean-Paul Sculier
This review of pain management in lung cancer is based on the presentation of four cases of thoracic oncology patients with pain at various stages of their disease. The approach will be multidisciplinary, involving a thoracic oncologist, radiologist, thoracic and orthopaedic spine surgeon, radiation therapist, pain medicine specialist, and palliative care specialist. This multispecialty approach to the management of different painful presentations in thoracic oncology will demonstrate the complexity of each case and the improved patient outcomes which result from the involvement of different disciplines working in concert...
September 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28861414/continuous-spinal-anesthesia-for-obstetric-anesthesia-and-analgesia
#2
REVIEW
Ivan Veličković, Borislava Pujic, Charles W Baysinger, Curtis L Baysinger
The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28840489/plain-radiography-in-patients-treated-with-intrathecal-drug-delivery-using-an-implantable-pump-device
#3
Elmar M Delhaas, Biswadjiet S Harhangi, Sander P G Frankema, Frank J P M Huygen, Aad van der Lugt
OBJECTIVES: Intrathecal drug administration using an implanted pump system is well established in intractable spasticity and pain. However, despite continuous advancements in manufacturing technology, adverse events related to the pump and catheter still occur. Most of them, such as migration, damage, disconnection and occlusion, are related to the spinal catheter. The aim of this overview is to update radiologists on how plain radiography of the implanted delivery system for intrathecal drug administration should be interpreted and to increase awareness for the need of urgent and timely multidisciplinary troubleshooting...
August 24, 2017: Insights Into Imaging
https://www.readbyqxmd.com/read/28832240/-was-it-worth-it-intrathecal-analgesia-for-cancer-pain-a-qualitative-study-exploring-the-views-of-family-carers
#4
Nishi Patel, Melanie Huddart, Helen Makins, Theresa Mitchell, Jane L Gibbins, Juan Graterol, Deborah Stevens, Paul Perkins
BACKGROUND: Intrathecal drug delivery is known to reduce pain in patients where conventional systemic analgesia has been ineffective or intolerable. However, there is little information regarding the effects of intrathecal drug delivery on quality of life and function in those with advanced, incurable cancer. AIM: Retrospective exploration of the views of bereaved carers regarding the physical and psychosocial effects of external tunnelled intrathecal drug delivery in patients with advanced incurable cancer...
August 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28808608/intrathecal-catheter-associated-inflammatory-mass-in-a-neurofibromatosis-type-1-patient-receiving-fentanyl-and-bupivacaine
#5
Derek G Southwell, Joseph A Osorio, Christopher S Liverman, Lauren M Friedman, Ramana K Naidu, Lawrence R Poree, Melanie M Henry, Line Jacques
BACKGROUND: Catheter-associated inflammatory masses (CIMs) are a rare but serious complication of intrathecal drug delivery devices. CIM formation is influenced by local medication concentration, which is determined in part by flow dynamics at the catheter tip. Underlying spinal pathologies, such as neoplasms, may alter flow at the catheter tip, thereby contributing to CIM formation. Moreover, they may also complicate the clinical and radiologic diagnosis of a CIM. CASE DESCRIPTION: A 36-year-old man with neurofibromatosis type 1 presented to our emergency department with complaints of increased back pain and leg weakness...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28780368/atlanto-occipital-catheterization-of-young-rats-for-long-term-drug-delivery-into-the-lumbar-subarachnoid-space-combined-with-in-vivo-testing-and-electrophysiology-in-situ
#6
Olga Kopach, Volodymyr Krotov, Nana Voitenko
BACKGROUND: Catheterization has been widely used in neuroscience and pain research for local drug delivery. Though different modifications were developed, the use of young animals for spinal catheterization remains limited because of a little success rate. A reliable technique is needed to catheterize young animals aimed for in vivo testing combined with spinal cord electrophysiology, often limited by animal age, to facilitate pain research. NEW METHODS: We describe intrathecal catheterization of young rats (3-week-old) through atlanto-occipical approach for long-lasting drug delivery into the lumbar subarachnoid space...
August 2, 2017: Journal of Neuroscience Methods
https://www.readbyqxmd.com/read/28767472/intrathecal-migration-of-an-epidural-catheter-while-using-a-programmed-intermittent-epidural-bolus-technique-for-labor-analgesia-maintenance-a-case-report
#7
Francesca Betti, Brendan Carvalho, Edward T Riley
We describe a case of intrathecal migration of a wire-reinforced epidural catheter in a parturient who received epidural labor analgesia. Epidural analgesia was initiated with a combined-spinal epidural technique and maintained by programmed intermittent epidural boluses. Epidural catheter aspiration after insertion was negative for cerebrospinal fluid. The patient's response to the first four doses of local anesthetic was consistent with epidural drug delivery. After the fifth dose, she developed a complete lower extremity motor block, hypotension, and high sensory blockade...
August 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28719859/-curcumin-loaded-poly-d-l-lactide-co-glycolide-nanovesicles-induce-antinociceptive-effects-and-reduce-pronociceptive-cytokine-and-bdnf-release-in-spinal-cord-after-acute-administration-in-mice
#8
Stefano Pieretti, Amalendu P Ranjan, Amalia Di Giannuario, Anindita Mukerjee, Francesca Marzoli, Rita Di Giovannandrea, Jamboor K Vishwanatha
Given the poor bioavailability of curcumin, its antinociceptive effects are produced after chronic intravenous administration of high doses, while poly (d,l-lactide-co-glycolide)-loaded vesicles (PLGA) can improve drug delivery. This paper investigates the antinociceptive effects of curcumin-loaded PLGA nanovesicles (PLGA-CUR) administered via intravenous (i.v.) or intrathecal (i.t.) routes at low and high doses. The following models of pain were used: formalin test, zymosan-induced hyperalgesia and sciatic nerve ligation inducing neuropathic allodynia and hyperalgesia...
July 10, 2017: Colloids and Surfaces. B, Biointerfaces
https://www.readbyqxmd.com/read/28719378/chemical-stability-of-morphine-ropivacaine-and-ziconotide-in-combination-for-intrathecal-analgesia
#9
Julien Robert, Jérémy Sorrieul, Elsa Rossignol, Hélène Beaussart, Hélène Kieffer, Caroline Folliard, Denis Dupoiron, Catherine Devys
Pain is the most feared symptom amongst individuals living with cancer. In 15% to 20% of patients, conventional analgesic therapy either fails to relieve pain or induces adverse effects. Intrathecal drug delivery systems may present an effective alternative for pain management. The Cancerology Center Paul Papin protocol includes an admixture of morphine, ropivacaine, and ziconotide in intrathecal preparations. These drugs are administered by a fully implantable or an external pump. Syringes or polyolefin infusion bags are prepared for refill just before use...
July 2017: International Journal of Pharmaceutical Compounding
https://www.readbyqxmd.com/read/28664409/surfen-is-a-broad-spectrum-calcium-channel-inhibitor-with-analgesic-properties-in-mouse-models-of-acute-and-chronic-inflammatory-pain
#10
Paula Rivas-Ramirez, Vinicius M Gadotti, Gerald W Zamponi, Norbert Weiss
Multiple voltage-gated calcium channels (VGCCs) contribute to the processing of nociceptive signals in primary afferent fibers. In addition, alteration of calcium channel activity is associated with a number of chronic pain conditions. Therefore, VGCCs have emerged as prime target for the management of either neuropathic or inflammatory pain, and selective calcium channel blockers have been shown to have efficacy in animal models and in the clinic. However, considering that multiple calcium channels contribute pain afferent signaling, broad-spectrum inhibitors of several channel isoforms may offer a net advantage in modulating pain...
June 30, 2017: Pflügers Archiv: European Journal of Physiology
https://www.readbyqxmd.com/read/28570482/targeting-the-s1p-s1pr1-axis-mitigates-cancer-induced-bone-pain-and-neuroinflammation
#11
Shaness A Grenald, Timothy M Doyle, Hong Zhang, Lauren M Slosky, Zhoumou Chen, Tally M Largent-Milnes, Sarah Spiegel, Todd W Vanderah, Daniela Salvemini
Metastatic bone pain is the single most common form of cancer pain and persists as a result of peripheral and central inflammatory, as well as neuropathic mechanisms. Here, we provide the first characterization of sphingolipid metabolism alterations in the spinal cord occurring during cancer-induced bone pain (CIBP). Following femoral arthrotomy and syngenic tumor implantation in mice, ceramides decreased with corresponding increases in sphingosine and the bioactive sphingolipid metabolite, sphingosine 1-phosphate (S1P)...
September 2017: Pain
https://www.readbyqxmd.com/read/28520273/efficacy-of-a-targeted-drug-delivery-on-demand-bolus-option-for-chronic-pain
#12
Robert B Bolash, Tariq Niazi, Meera Kumari, Gerges Azer, Nagy Mekhail
BACKGROUND AND OBJECTIVES: Intrathecal targeted drug delivery systems historically required a physician's office visits for dose adjustment to manage fluctuating pain. A wireless device now enables patients to supplement their basal intrathecal infusion with a programmed on-demand bolus dose. We sought to quantify the change in oral breakthrough opioid need associated with the use of an intrathecal bolus in comparison to those treated with the basal infusion alone. METHODS: Demographic, dosage, bolus usage and longevity data were extracted from the historical medical record of 69 patients (18/51 bolus/non-bolus) followed continuously at our center...
May 18, 2017: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/28492438/advancing-safety-in-intrathecal-analgesia-a-novel-web-based-pharmacologic-requisition-platform-and-data-repository-for-intrathecal-drug-delivery-devices
#13
Christopher M Sobey, Chad R Greene, Lindsay J Ford, Jenna L Walters, Marc A Huntoon
No abstract text is available yet for this article.
July 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28489466/intrathecal-injection-of-gadobutrol-a-tale-of-caution
#14
Corey Reeves, Enrique Galang, Raj Padalia, Nam Tran, Devang Padalia
In the field of interventional pain medicine a radiocontrast agent is commonly used in conjunction with fluoroscopy. Limited work has been published regarding the use of gadolium based contrast agents (GBCA) in the intrathecal space. We report a case of an intrathecal gadobutrol injection resulting in neurotoxic manifestations.A 60-year-old female with a history significant for lumbar post-laminectomy syndrome and intrathecal drug delivery implantation was admitted for lumbar fusion and kyphoplasty. Postoperatively, the patient had escalating pain medication requirements...
June 2017: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/28458952/intrathecal-baclofen-pump-infection-treated-by-adjunct-intrareservoir-teicoplanin-instillation
#15
Rovlias Aristedis, Papoutsakis Dimitrios, Paidakakos Nikolaos, Blionas Alexandros
BACKGROUND: The delivery of intrathecal baclofen via pumps is gaining increasing use in the management of intractable spasticity. One of the rare but devastating complications of this method is infection. In the majority of cases, removal of the device is required, despite appropriate intravenous antibiotic therapy. We report a case that highlights the use of intrareservoir teicoplanin to achieve sterilization of the infected pump system in a patient in whom removal of the pump was not an easy option...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28453954/local-delivery-of-chondroitinase-abc-with-or-without-stromal-cell-derived-factor-1%C3%AE-promotes-functional-repair-in-the-injured-rat-spinal-cord
#16
Malgosia M Pakulska, Charles H Tator, Molly S Shoichet
Traumatic spinal cord injury (SCI) is a devastating event for which functional recovery remains elusive. Due to the complex nature of SCI pathology, a combination treatment strategy will likely be required for success. We hypothesized that tissue and functional repair would be achieved in a rat model of impact-compression SCI by combining degradation of the glial scar, using chondroitinase ABC (ChABC), with recruitment of endogenous neural precursor cells (NPCs), using stromal cell-derived factor 1α (SDF)...
July 2017: Biomaterials
https://www.readbyqxmd.com/read/28431428/computational-and-in-vitro-experimental-investigation-of-intrathecal-drug-distribution-parametric-study-of-the-effect-of-injection-volume-cerebrospinal-fluid-pulsatility-and-drug-uptake
#17
COMPARATIVE STUDY
Kevin M Tangen, Roxanne Leval, Ankit I Mehta, Andreas A Linninger
BACKGROUND: Intrathecal drug delivery is an attractive option to circumvent the blood-brain barrier for pain management through its increased efficacy of pain relief, reduction in adverse side effects, and cost-effectiveness. Unfortunately, there are limited guidelines for physicians to choose infusion or drug pump settings to administer therapeutic doses to specific regions of the spine or the brain. Although empiric trialing of intrathecal drugs is critical to determine the sustained side effects, currently there is no inexpensive in vitro method to guide the selection of spinal drug delivery parameters...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28426576/personalized-intrathecal-drug-delivery-models-targets-and-approaches
#18
Jonathan P Wanderer, Naveen Nathan
No abstract text is available yet for this article.
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28393436/intrathecal-pump-refills-pocket-fills-and-symptoms-of-drug-overdose-a-prospective-observational-study-comparing-the-injected-drug-volume-vs-the-drug-volume-effectively-measured-inside-the-pump
#19
Paolo Maino, Roberto S G M Perez, Eva Koetsier
OBJECTIVES: One complication associated with the refill procedure of intrathecal drug delivery systems (IDDSs) include a "pocket fill," which is the inadvertent injection of the drug into the subcutaneous space surrounding the pump. The purpose of our study was to assess the mean volume discrepancy between the injected and the effective drug volume inside the IDDS reservoir after refills that did not lead to signs of overdose and to record at which volume discrepancy symptoms of overdose were noticed...
April 10, 2017: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/28381927/the-effects-of-minocycline-on-spinal-root-avulsion-injury-in-rat-model
#20
Tan Yew Chin, Sim Sze Kiat, Hizal Ghazali Faizul, Wutian Wu, Jafri Malin Abdullah
BACKGROUND: The neuroprotective role of minocycline in the treatment of brachial plexus injury is controversial. OBJECTIVE: To study the neuroprotective effect of minocycline via different routes in adult Sprague Dawley rats with brachial plexus injury. METHODS: The C7 nerve roots of the animals were avulsed via an anterior extravertebral approach. Traction force was used to transect the ventral motor nerve roots at the preganglionic level...
March 2017: Malaysian Journal of Medical Sciences: MJMS
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