Presented at the 2012 AAPM Annual Meeting « Back

Post-Dural Puncture Headache Following Intrathecal Drug Delivery System Placement

Stephanie A. Neuman, MD, neuman.stephanie@mayo.edu¹, Jason S. Eldrige, MD¹, Wenchun Qu, MD PhD¹, Eric Freeman, MD¹, Bryan C. Hoelzer, MD¹, (1) Mayo Clinic, Rochester, Minnesota

Introduction: The implantation of an intrathecal drug delivery system (IDDS) can provide significant pain and/or spasticity relief for patients with malignant pain, nonmalignant pain, and those with intractable spasticity.1-6 Unfortunately, placement of these devices is not without complications. Minimal data exists describing the rates of these complications. Specifically, there is a paucity of data describing the incidence of post dural puncture headache (PDPH) following placement.7-9 We sought to identify this rate and subsequent treatment course. Methods: Following IRB approval, 20 years worth of IDDS placement data at Mayo Clinic in Rochester, MN was collected. Two hundred sixty-seven surgical reports in 238 patients were identified as having an IDDS placed or revised for intractable pain or spasticity. In addition to documenting demographic information, the number of dural punctures, techniques for sealing dural leak, and details of PDPH, if present, were collected. Results: Of the 267 surgical procedures that met inclusion criteria, PDPH was reported in 55 procedures (21%). No statistically significant associations were found in regards to data collected and development of PDPH. Of those that did develop a PDPH, 75% (41/55) were able to be managed conservatively (bed rest, IV fluids, analgesics, antiemetics). Twenty five percent (14/55) did require an epidural blood or fibrin glue patch after failed conservative measures. Conclusions: Development of PDPH following IDDS placement is not an uncommon complication. Fortunately, the majority of these patients can be managed with conservative measures. A small minority of patients do require blood or fibrin glue patch for control of symptoms. References: 1)1. Coffey RJ, Owens ML, Broste SK, et al. Mortality Associated with Implantation and Management of Intrathecal Opioid Drug Infusion Systems to Treat Noncancer Pain. Anesthesiology. 2009;11:881-91. 2)2. Deer TR, Smith HS, Burton AW, et al. Comprehensive Consensus Based Guidelines on Intrathecal Drug Delivery Systems in the Treatment of Pain Caused by Cancer Pain. Pain Physician. 2011; 14:E283-312. 3)3. Deer TR, Smith HS, Cousins M, et al. Consensus Guidelines for the Selection and Implantation of Patients with Noncancer Pain for Intrathecal Drug Delivery. Pain Physician. 2010;13:E175-213. 4)4. Deer T, Krames ES, Hassenbusch SJ, et al. Polyanalgesic Consensus Conference 2007: Recommendations for the Management of Pain by Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel. Neuromodulation. 2007;10:300-28. 5)5. Ruan X. Drug-Related Side Effects of Long-term Intrathecal Morphine Therapy. Pain Physician. 2007;10:357-65. 6)6. Stearns L, Boortz-Marx R, Du Pen S, et al. Intrathecal Drug Delivery for the Management of Cancer Pain: A Multidisciplinary Consensus of Best Clinical Practices. The Journal of Supportive Oncology. 2005;3:399-408. 7)7. Follett KA, Naumann CP. A Prospective Study of Catheter-Related Complications of Intrathecal Drug Delivery Systems. Journal of Pain and Symptom Management. 2000;19:209-15. 8)8. Kamran S, Wright BD. Complications of Intrathecal Drug Delivery Systems. Neuromodulation. 2001;4:111-15. 9)9. Turner JA, Sears JM, Loeser JD. Programmable Intrathecal Opioid Delivery Systems for Chronic Noncancer Pain: A Systematic Review of Effectiveness and Complications. Clinical Journal of Pain. 2007;23:180-95.

Funding: None