Cancer Pump Trialing: Trial Insertion and Follow Up

We have had several patients refuse to give the trial pump back because they did not want their pain to return.

Most of the trials that we conduct are epidural infusions similar to those given to pregnant women in labor. The reason for this is that epidural infusions minimize the risk of headache and other complications, while adequately answering the two questions of efficacy and side effects discussed previously. In some cases owing to abnormalities within the spinal column or to the type of medication used for the trial an intrathecal infusion or a single intrathecal instillation will be chosen.

 

Patients are face down placed on a special abdominal pillow. The back is cleansed three times with an antiseptic solution. The skin and subcutaneous tissues are infiltrated with local anesthetic. The epidural needle is placed under fluoroscopic control and the epidural catheter (a thin, soft, flexible plastic tube) is inserted through the needle and advanced to the desired location in the spine. X-Ray contrast is then injected to confirm the accurate placement of the catheter as well as adequate spread of the medication. The whole procedure takes about 5 minutes and most patients say that it is no more painful than having their blood drawn.

 

The trial pump is then connected and programmed. The patient is observed for 1-2 hours and then discharged. A follow up phone call is made on the evening of insertion and the patient is seen in the office everyday for the length of the trial.

 

Trials usually last 1-2 days. In my experience, if substantial benefit cannot be shown in that period of time the patient is poor candidate and probably should not be implanted. Furthermore, the risk of infection rises with every day that the catheter remains in the back. On occasion, however, we have allowed trials to go on for almost a week, when the patient flatly refuses to give the trial pump and medication back. I do however, insist that everything be removed 24 hours prior to final implantation to minimize the risk of infection.

 

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