BACKGROUND Epidural analgesia initiated early in labor (when the cervix is less than 4.0 cm dilated) has been associated with an increased risk of cesarean delivery. It is unclear, however, whether this increase in risk is due to the analgesia or is attributable to other factors. METHODS We conducted a randomized trial of 750 nulliparous women at term who were in spontaneous labor or had spon...

BACKGROUND Previous studies have demonstrated that the addition of intrathecal fentanyl to a spinal anesthetic for cesarean delivery improves intraoperative analgesia. However, intrathecal fentanyl may induce acute tolerance to opioids. The objective of this study was to investigate whether the addition of intrathecal fentanyl to spinal anesthesia with intrathecal morphine increases postoperati...

EXTRAMEDULLARY intrathecal granuloma formation is a rare complication of morphine administration via implanted drug delivery systems. We present a unique case of a granuloma adherent to the conus medullaris presenting as cauda equina syndrome. Practitioners should not assume that implantation of intrathecal catheters with their tips located at or below the conus medullaris will eliminate all ri...

BACKGROUND Intrathecal drug delivery systems represent an increasingly common treatment modality for patients with a variety of conditions, including chronic pain and spasticity. Pumps rely on electronic programming to properly control and administer highly concentrated medications. Electromagnetic interference (EMI) is a known exposure that may cause a potential patient safety issue stemming f...

Intravenous enzyme replacement therapy with iduronate-2-sulfatase is an approved treatment for Hunter syndrome, however, conventional intravenous delivery cannot treat the neurologic manifestations of the disease due to its limited central nervous system penetration. Intrathecal administration of iduronate-2-sulfatase for delivery to the central nervous system is currently under investigation. ...

It is useful for chemical neuromodulation of central nervous system to significantly reduce perception of pain by delivery of the drug. In simple terms, it is a completely internalized system comprising of an intrathecal catheter which is introduced in the fluid containing space around the spinal cord and connected to a drug reservoir sited in a pocket made under the skin. This facilitates admi...

BACKGROUND Various methods exist for trialing patients for intrathecal drug delivery. Currently no standards exist regarding "best practices" for trialing techniques. OBJECTIVES The specific aim of the current study is to report results of patients trialed using a low-dose intrathecal morphine technique in the treatment of chronic noncancer pain. SETTING academic pain medicine practice ST...

BACKGROUND AND AIMS Regional analgesia is commonly used for the relief of labour pain, Prolongation of analgesia can be achieved by adjuvant medications. The aim of this randomised controlled trial was to evaluate the efficacy of intrathecal levobupivacaine with dexamethasone for labour analgesia. METHODS A total of 80 females were included in this study, all were primigravidas undergoing vag...

Targeting analgesic drugs for spinal delivery reflects the fact that while the conscious experience of pain is mediated supraspinally, input initiated by high intensity stimuli, tissue injury and/or nerve injury is encoded at the level of the spinal dorsal horn and this output informs the brain as to the peripheral environment. This encoding process is subject to strong upregulation resulting i...

The intrathecal drug delivery system (ITDDS), an effective treatment tool for intractable spasticity and pain, is associated with various complications but breakage of the catheter is rare. We report the case of a 50-yr-old man with ITDDS, in whom an intrathecal catheter was severed, resulting in a 28.6-cm-long intrathecal fragment. The catheter completely retracted into the intrathecal space f...