Intraspinal Drug Infusion

  • Sergio Canavero
  • Vincenzo Bonicalzi
Chapter

Abstract

Several drugs have been administered intrathecally (IT) in attempting to treat CP. Unfortunately, no well-designed studies with homogeneous groups of patients and long-term follow-up are available for definite conclusions. However, drug combinations (e.g., midazolam/clonidine/bupi- or ropivacaine or baclofen/clonidine/bupi- or ropivacaine) may be more effective; tolerance may develop more slowly. Since the dosage of each single drug is reduced, side effects might be fewer—although not necessarily. Intraspinal infusion is not risk-free: aside from generic ones (catheter dislodgement [IT>epidural], root irritation [IT>epidural], reactive arachnoiditis [IT>epidural]), infective complications are the most feared, with occasional mortality; bleeding, neurological injury, and cerebrospinal leaks are also possible. Intermittent boluses or continuous infusion shows no difference in predicting trial and long-term success, at least for opioids [1]; a positive preimplantation test does not guarantee long-term relief.

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Sergio Canavero
    • 1
  • Vincenzo Bonicalzi
    • 2
  1. 1.HEAVEN/GEMINI International Collaborative GroupTurinItaly
  2. 2.AOUCittà della Salute e della Scienza di Torino, Department of Neurosciences, Rita Levi MontalciniUniversità di TorinoTurinItaly

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