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Intrathecal Drug Delivery

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https://www.readbyqxmd.com/read/29769077/magnetic-field-distribution-modulation-of-intrathecal-delivered-ketorolac-iron-oxide-nanoparticle-conjugates-produce-excellent-analgesia-for-chronic-inflammatory-pain
#1
Ping-Ching Wu, Dar-Bin Shieh, Hung-Tsung Hsiao, Jeffery Chi-Fei Wang, Ya-Chi Lin, Yen-Chin Liu
BACKGROUND: Nanoparticles have become one of the most promising among the potential materials used for biomedical applications. However, few researchers have focused on their effects on analgesia. Despite the fact that various nanoparticles have been evaluated for drug delivery and MRI imaging contrast enhancement in clinical settings, no reports have investigated the in vivo synergy of ketorolac iron-oxide nanoparticle conjugates to improve the analgesic effect. METHODS: Ketorolac conjugated magnetic iron oxide nanoparticles (Keto-SPIO) were synthesized via two-stage additions of protective agents and chemical co-precipitation...
May 16, 2018: Journal of Nanobiotechnology
https://www.readbyqxmd.com/read/29719742/toxic-myelitis-and-arachnoiditis-after-intrathecal-delivery-of-bupivacaine-via-an-implanted-drug-delivery-system-case-report-and-review-of-the-literature
#2
Meng Huang, Brian Dalm, Richard K Simpson
The off-label usage of amino-amide anesthetics in intrathecal drug delivery systems (IDDS) for the treatment of chronic non-malignant and malignant pain is supported in the polyanalgesic consensus guidelines as a second-line adjunctive therapy. Although strong evidence for its clinical efficacy is lacking, its clinical safety profile has been well established within established dosing parameters. Despite the rarity of neurological adverse reactions to intrathecal bupivacaine, whether given as regional anesthesia or intrathecal therapy, neurologic morbidity associated with its administration is well documented...
February 27, 2018: Curēus
https://www.readbyqxmd.com/read/29649397/management-of-a-cancer-patient-with-an-intrathecal-drug-delivery-system-and-an-acute-brain-abscess
#3
David R Walega, Marc Korn
Surgical-site infection, spinal cord abscess, and catheter tip granuloma are known but rare complications of intrathecal drug delivery systems (IDDS). To date, there are no published cases of brain abscess in a patient with an IDDS. In this study, we report a case of a cancer patient with an IDDS for management of cancer pain who developed a brain abscess with profound mental status changes and clinical management challenges.
March 13, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29628561/norepinephrine-versus-ephedrine-to-maintain-arterial-blood-pressure-during-spinal-anesthesia-for-cesarean-delivery-a-prospective-double-blinded-trial
#4
Ali Mohamed Ali Elnabtity, Mohamed Foad Selim
Background: Ephedrine was conventionally regarded as the first-choice drug to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, due to its stimulant activity on α- and β-adrenergic receptors. Norepinephrine is a weak β-adrenergic and potent α-adrenergic receptor agonist. Therefore, it may be suitable for maintaining blood pressure with less chronotropic effects compared to ephedrine. Patients and Methods: One hundred and forty healthy patients having cesarean delivery under spinal anesthesia were randomized to Group N ( n = 61) who received a prophylactic bolus of norepinephrine 5 μg intravenous (i...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29617640/rna-targeted-therapeutics
#5
REVIEW
Stanley T Crooke, Joseph L Witztum, C Frank Bennett, Brenda F Baker
RNA-targeted therapies represent a platform for drug discovery involving chemically modified oligonucleotides, a wide range of cellular RNAs, and a novel target-binding motif, Watson-Crick base pairing. Numerous hurdles considered by many to be impassable have been overcome. Today, four RNA-targeted therapies are approved for commercial use for indications as diverse as Spinal Muscular Atrophy (SMA) and reduction of low-density lipoprotein cholesterol (LDL-C) and by routes of administration including subcutaneous, intravitreal, and intrathecal delivery...
April 3, 2018: Cell Metabolism
https://www.readbyqxmd.com/read/29574121/sacral-neuromodulation-and-twiddler-s-syndrome
#6
Ted M Roth
Twiddler's syndrome is the deliberate, inadvertent, or subconscious manipulation of an implantable generator within its subcutaneous pocket which can lead to malposition and fracture of the associated lead.1 The syndrome is well-recognized in patients with pacemakers, implantable cardioverter-defibrillators, deep brain stimulators and more recently in intrathecal drug delivery devices.1-3 Here we present an instance of Twiddler's syndrome after sacral neuromodulation [SNM].
March 21, 2018: Urology
https://www.readbyqxmd.com/read/29543644/intrathecal-drug-delivery-systems-for-refractory-pancreatic-cancer-pain-observational-follow-up-study-over-an-11-year-period-in-a-comprehensive-cancer-center
#7
Gabriel Carvajal, Denis Dupoiron, Valerie Seegers, Nathalie Lebrec, François Boré, Pierre-Yves Dubois, Damien Leblanc, Thierry Delorme, Sabrina Jubier-Hamon
BACKGROUND: Pancreatic cancer is the fourth leading cause of cancer-related death in Europe and the United States. Studies have demonstrated that patients with pancreatic cancer have a high prevalence of pain, with rates varying from 47% to 82%. Analgesia using intrathecal drug delivery systems (IDDS) has been poorly studied specifically in this population. METHODS: The IDDS for pancreatic cancer pain was a follow-up observational study designed to evaluate 11-year results of IDDS for refractory pancreatic cancer pain at the Institut de Cancérologie de L'Ouest, Paul Papin in France...
March 14, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29480977/unique-intradural-inflammatory-mass-containing-precipitated-morphine-confirmatory-analysis-by-lesa-ms-and-maldi-ms
#8
Alexander J Kim, Sankha Basu, Carolyn Glass, Edgar L Ross, Nathalie Agar, Qing He, David Calligaris
Opioids are often used for analgesia via continuous intrathecal delivery by implantable devices. A higher concentration and daily dose of opioid have been postulated as risk factors for intrathecal granuloma formation. We present a 42-year-old female patient with chronic abdominal pain from refractory pancreatitis, with an intrathecal drug delivery device implanted 21 years prior, delivering continuous intrathecal morphine. After many years without concerning physical signs or complaints, with gradual increases in daily morphine dose, she presented with rapidly progressive neurologic deficits, including lower extremity, bladder, and bowel symptoms...
February 26, 2018: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/29446171/retrospective-analysis-of-intrathecal-drug-delivery-outcomes-efficacy-and-risk-for-cancer-related-pain-at-a-high-volume-academic-medical-center
#9
Dawood Sayed, Forrest Monroe, Walter N Orr, Milind Phadnis, Talal W Khan, Edward Braun, Smith Manion, Andrea Nicol
OBJECTIVES: Cancer pain is common and difficult to treat, as conservative medical management fails in approximately 20% of patients for reasons such as intolerable side-effects or failure to control pain. Intrathecal drug delivery systems (IDDS), while underutilized, can be effective tools to treat intractable cancer pain. This study aims to determine the degree of pain relief, efficacy, and safety of patients who underwent IDDS implantation at a multidisciplinary pain clinic. MATERIALS AND METHODS: A retrospective review was conducted of patients with an intrathecal pain pump implanted for malignant pain...
February 14, 2018: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/29404792/intrathecal-drug-delivery-and-spinal-cord-stimulation-for-the-treatment-of-cancer-pain
#10
REVIEW
Fangfang Xing, R Jason Yong, Alan David Kaye, Richard D Urman
PURPOSE OF REVIEW: The purpose of the present investigation is to summarize the body and quality of evidence including the most recent studies in support of intrathecal drug delivery systems and spinal cord stimulation for the treatment of cancer-related pain. RECENT FINDINGS: In the past 3 years, a number of prospective studies have been published supporting intrathecal drug delivery systems for cancer pain. Additional investigation with adjuvants to morphine-based analgesia including dexmedetomidine and ziconotide support drug-induced benefits of patient-controlled intrathecal analgesia...
February 5, 2018: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/29351097/effect-of-epidural-infusion-bolus-delivery-rate-on-the-duration-of-labor-analgesia-a-randomized-clinical-trial
#11
Elizabeth M S Lange, Cynthia A Wong, Paul C Fitzgerald, Wilmer F Davila, Suman Rao, Robert J McCarthy, Paloma Toledo
BACKGROUND: Programmed intermittent boluses of local anesthetic have been shown to be superior to continuous infusions for maintenance of labor analgesia. High-rate epidural boluses increase delivery pressure at the catheter orifice and may improve drug distribution in the epidural space. We hypothesized that high-rate drug delivery would improve labor analgesia and reduce the requirement for provider-administered supplemental boluses for breakthrough pain. METHODS: Nulliparous women with a singleton pregnancy at a cervical dilation of less than or equal to 5 cm at request for neuraxial analgesia were eligible for this superiority-design, double-blind, randomized controlled trial...
April 2018: Anesthesiology
https://www.readbyqxmd.com/read/29346227/refractory-pain-management-in-amyloid-associated-peripheral-neuropathy
#12
Nafisseh S Warner, James C Watson, Markus A Bendel, Susan M Moeschler
OBJECTIVE: Systemic amyloidosis is a disease that often involves multiple organ systems, including the peripheral nervous system. Patients may present with severe, refractory neuropathic pain; however, the optimal treatment approach for pain for these patients remains unclear. CASE REPORT: A man with severe, refractory neuropathic pain in his bilateral upper and lower extremities and the trunk secondary to amyloid neuropathy is presented. Multiple medication trials, including neuropathic and opioid agents, produced considerable adverse effects and minimal relief...
January 17, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29285413/minimally-invasive-repair-of-a-pseudomeningocele-caused-by-a-sheared-intrathecal-catheter-following-implantation-of-a-drug-delivery-system
#13
S Raju, P O Champagne, L Walsh, Daniel J Denis
Background: Shearing of an intrathecal catheter during implantation of a drug delivery system is an underreported complication that can be challenging to manage. Case Description: A 53-year-old man with refractory cancer pain had an intrathecal pump system implanted. The procedure was complicated with catheter shear and retention in the intrathecal space. A second catheter was successfully placed but formation of a painful pseudomeningocele and ineffective pain relief complicated the outcome...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/29277248/communication-pathways-to-and-from-the-inner-ear-and-their-contributions-to-drug-delivery
#14
REVIEW
Alec N Salt, Keiko Hirose
The environment of the inner ear is highly regulated in a manner that some solutes are permitted to enter while others are excluded or transported out. Drug therapies targeting the sensory and supporting cells of the auditory and vestibular systems require the agent to gain entry to the fluid spaces of the inner ear, perilymph or endolymph, which surround the sensory organs. Access to the inner ear fluids from the vasculature is limited by the blood-labyrinth barriers, which include the blood-perilymph and blood-strial barriers...
December 19, 2017: Hearing Research
https://www.readbyqxmd.com/read/29206310/ease-of-fill-port-access-during-the-ultrasound-guided-vs-the-blind-refill-technique-of-intrathecal-drug-delivery-systems-with-a-raised-septum-a-prospective-comparison-study
#15
Paolo Maino, Sander M J van Kuijk, Roberto S G M Perez, Eva Koetsier
OBJECTIVES: The localization of the reservoir fill port of Intrathecal Drug Delivery Devices (IDDS) can be difficult. The purpose of this study was to assess the ease of fill port access during the ultrasound-guided refill technique compared to the blind refill technique in IDDSs with a raised septum on the pump surface. MATERIALS AND METHODS: Written informed consent was obtained from 19 adult patients undergoing regular refills of their Raised Septum IDDSs (RS-IDDSs)...
December 5, 2017: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/29130140/transforaminal-intrathecal-delivery-of-nusinersen-using-cone-beam-computed-tomography-for-children-with-spinal-muscular-atrophy-and-extensive-surgical-instrumentation-early-results-of-technical-success-and-safety
#16
John J Weaver, Niranjana Natarajan, Dennis W W Shaw, Susan D Apkon, Kevin S H Koo, Giri M Shivaram, Eric J Monroe
BACKGROUND: Nusinersen, the only treatment approved by the United States Food and Drug Administration for spinal muscular atrophy (SMA), is delivered intrathecally. Many children with SMA have extensive spinal instrumentation and deformities, often precluding the use of standard approaches for gaining intrathecal access. Furthermore the anatomical distortion that often occurs with rotoscoliosis can complicate the use of fluoroscopic guidance. Compared to fluoroscopy, CT affords superior guidance for complex needle placements...
March 2018: Pediatric Radiology
https://www.readbyqxmd.com/read/29119834/numerical-study-of-intrathecal-drug-delivery-to-a-permeable-spinal-cord-effect-of-catheter-position-and-angle
#17
G Pizzichelli, B Kehlet, Ø Evju, B A Martin, M E Rognes, K A Mardal, E Sinibaldi
Intrathecal delivery is a procedure involving the release of therapeutic agents into the cerebrospinal fluid (CSF) hrough a catheter. It holds promise for treating high-impact central nervous system pathologies, for which systemic administration routes are ineffective. In this study we introduce a numerical model able to simultaneously account for solute transport in the fluid and in the spinal cord. Using a Discontinuous Galerkin method and a three-dimensional patient-specific geometry, we studied the effect of catheter position and angle on local spinal cord drug concentration...
November 2017: Computer Methods in Biomechanics and Biomedical Engineering
https://www.readbyqxmd.com/read/29112460/opioid-neurotoxicity-treated-with-intrathecal-drug-delivery-system-implant
#18
Thomas P Pittelkow, Kelly L Wu, Jacob J Strand, Susan M Moeschler
No abstract text is available yet for this article.
February 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29111148/effects-of-opioid-and-nonopioid-analgesics-on-canine-wheal-formation-and-cultured-human-mast-cell-degranulation
#19
Eric Schmidt-Rondon, Zhenping Wang, Shelle A Malkmus, Anna Di Nardo, Keith Hildebrand, Linda Page, Tony L Yaksh
Mast cell (MC) degranulation has been implicated in the side effect profile of a variety of clinically useful agents. Thus, after intrathecal delivery, formation of space-occupying, meningeally-derived masses may be related to local MC degranulation. We systematically characterized degranulating effects of opioid and nonopioid analgesics on cutaneous flares in the dog and in primary human MC (hMC) cultures. METHODS: Dogs were anesthetized with IV propofol and received intradermal (ID) injections (50μL)...
January 1, 2018: Toxicology and Applied Pharmacology
https://www.readbyqxmd.com/read/29064620/intrathecal-drug-delivery-systems-for-the-management-of-chronic-noncancer-pain-a-systematic-review-of-economic-evaluations
#20
REVIEW
Rui V Duarte, Tosin Lambe, Jon H Raphael, Sam Eldabe, Lazaros Andronis
BACKGROUND: Intrathecal drug delivery (ITDD) systems are one of a limited number of management options for chronic noncancer pain, cancer pain, and spasticity. Concerns over their effectiveness and high initial costs led National Health Service (NHS) England to decommission ITDD for patients with chronic noncancer pain. However, the extent to which this decision is in line with existing economic evidence is unclear. The aim of this systematic review was to identify and review the existing evidence on the cost effectiveness of ITDD for chronic noncancer pain...
October 24, 2017: Pain Practice: the Official Journal of World Institute of Pain
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