0      0

26th Napa Pain Conference

NPC26-F7-B - Intraspinal Drug Delivery Safety & Standardization

Aug 16, 2019 3:45pm ‐ Aug 16, 2019 5:30pm


Intraspinal Drug Delivery

Safety & Standardization

Target Audience: Clinicians supervising or providing direct care for patients with intrathecal drug delivery systems, and providers considering the use of IIDs

Learning Objectives

As a result of participating in this activity, learners will be better able to:

  • Implement strategies to prevent the two clinician-related factors that contribute to the most serious adverse events
  • Triage inflammatory catheter tip granulomas


Pharmacodynamics & Pharmacokinetics of Approved & Off-label IDDS Medications

Michael Saulino, MD, PhD

A Standardized Refill Protocol for Intrathecal Drug Delivery Systems

Lawrence Poree, MD, PhD, MPH


Intraspinal drug delivery (IDD) is a safe and efficacious method used to deliver medications for the treatment of chronic neurological disease that requires periodic reservoir refills that can place patients at risk for a rare, accidental but potentially life-threatening pocket fill. After clinicians have been refilling pump reservoirs for 5 years, 18% report at least one of these serious adverse events.

Additional Reading

  • Mcglothlen G & Rodriguez L. Training for the intraspinal drug delivery system reservoir refill procedure highly variable: A nationwide survey of health care professionals. Neuromodulation. 2017; 20(7):727-732.
  • Fitzgibbon, D. R., Stephens, L. S., Posner, K. L., Michna, E., Rathmell, J. P., Pollak, K. A., & Domino, K. B. (2016). Injury and liability associated with implantable devices for chronic pain. The Journal of the American Society of Anesthesiologists, 124(6), 1384-1393.
  • Deer, T. R., Pope, J. E., Hayek, S. M., Lamer, T. J., Veizi, I. E., Erdek, M., ... & Rosen, S. M. (2017). The Polyanalgesic Consensus Conference (PACC): recommendations for intrathecal drug delivery: guidance for improving safety and mitigating risks. Neuromodulation: Technology at the Neural Interface, 20(2), 155-176.
  • Deer, T. R., Pope, J. E., Hayek, S. M., Bux, A., Buchser, E., Eldabe, S., ... & Doleys, D. M. (2017). The polyanalgesic consensus conference (pacc): recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation: Technology at the Neural Interface, 20(2), 96-132.
  • McGlothlen, Gail, “Intraspinal Drug Delivery Reservoir Refill Procedure by Non-Physician Clinicians: A Nation-Wide Survey of Training, Pocket Fill Experience, and Life-Long Learning Behaviors” (2016). Doctoral Projects. 39.
  • American Society of Health-System Pharmacists Guidelines on Preventing Medication Errors in Hospitals
  • Pharmaceutical Compounding—Sterile Preparations (general information chapter 797). In: The United States Pharmacopeia, 36th rev., and the National Formulary, 31 ed. Rockville, MD: The United States Pharmacopeial Convention; 2013: 361–98
  • Adler, J. A., & Lotz, N. M. (2017). Intrathecal pain management: a team-based approach. Journal of Pain Research, 10, 2565.
  • McGivern, J. G. (2007). Ziconotide: a review of its pharmacology and use in the treatment of pain. Neuropsychiatric disease and treatment, 3(1), 69.
  • Hanna, M. H., Peat, S. J., Woodham, M., Knibb, A., & Fung, C. (1990). Analgesic efficacy and CSF pharmacokinetics of intrathecal morphine-6-glucuronide: comparison with morphine. British Journal of Anaesthesia, 64(5), 547-550.


  • Dr. Michael Saulino, MD, PhD, Clinical Director, Intrathecal Therapy Services, MossRehab
  • Dr. Lawrence Poree, MD, PhD. MPH, Clinical Professor, Department of Anesthesia, University of California at San Francisco (UCSF)

You must be logged in and own this session in order to post comments.