An implanted intrathecal drug delivery system does not switch itself off because the patient is having a hernia repair, and the two most common errors are opposite ones: assuming the pump is handling the analgesia, and assuming it is irrelevant.
Establish three things before induction. What is in the pump and at what daily dose — an intrathecal morphine dose of a few milligrams a day is an enormous systemic-equivalent, and the patient is not opioid-naive by any reading. Whether the reservoir has enough for the admission, because an unplanned overnight stay that runs a pump dry produces withdrawal, and intrathecal baclofen withdrawal in particular is a medical emergency rather than a discomfort. And where the catheter and pump sit, so that positioning, diathermy and any planned neuraxial block are planned around them rather than into them.
The practical defaults: keep the pump running at its usual settings unless a pain specialist has advised otherwise, do not treat the intrathecal dose as part of your systemic opioid budget, and avoid a neuraxial puncture at a level where the catheter runs. If the surgery involves the abdomen or the back, tell the surgeon the device is there — a pocket in the anterior abdominal wall is easy to encounter unexpectedly.
- Document drug, concentration, daily dose and reservoir volume before induction.
- Keep the pump at existing settings unless the implanting service says otherwise.
- Do not count the intrathecal dose towards systemic opioid; titrate systemic analgesia separately and cautiously.
- Treat suspected intrathecal baclofen withdrawal as an emergency and involve the implanting centre immediately.
- Flag the device to the surgeon and to radiology before any imaging or diathermy near the pocket.
Why it matters
The commonest harm around these devices comes from treating them as either the whole answer or none of it.
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