Intrathecal Catheter

Intrathecal therapy began to emerge in the late 1970s when the World Health Organization (WHO) placed attention on a more careful treatment of cancer pain. Later on, the interest in the use of intrathecal catheters for intrathecal administrations of drugs increased after the clinical demonstration of the efficacy of intrathecal morphine. In 1978, indeed, Wang et al. and later, Ventafridda et al. demonstrated that subarachnoid injections of morphine attenuated pain in cancer patients.[1][2] The next step was the intrathecal administration of morphine through implantable reservoirs. The first to describe the use of an implantable pump for the administration of intrathecal drugs was Onofrio, in 1981, followed by several clinical cases and several clinical investigations.[3][4][5] With proven efficacy, intrathecal therapy quickly came into use for the management of intractable pain for both cancer and non-cancerous pain.[6] An intrathecal catheter can also be used to prevent post-dural puncture headache (PDPH) following an accidental dural puncture during epidural anesthesia (e.g., in parturients).[7] Through this approach, the catheter can be used to provide analgesia (local anesthetics) and gets removed after at least 24 hours. Finally, since 1984, intrathecal therapy has also been used for severe spasticity in individuals affected by multiple sclerosis (MS), spinal cord injury (SCI), cerebral palsy (CP), and in patients with acquired brain injury (stroke). In the management of spasticity, baclofen is the recommended pharmacological treatment of choice.[8] Attempts have also been made to use intrathecal baclofen for the treatment of tetanus spasticity.[9] In summary: The advantages of intrathecal therapy include better analgesia with fewer side effects and a lower dose of drugs administered as the drug is taken directly to the receptors with a good impact on severe spasticity in adults and children. The disadvantages include the risks associated with the procedure, infections, side effects of the drugs administered, and costs.