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May
2000
Long-term Spinal Analgesic
Delivery: A Review of the Preclinical and Clinical Literature
Wallace M, Yaksh TL.
Regional Anesthesia and Pain Medicine 2000; 25:117-157.
Commentary
by Richard W. Rosenquist,
M.D.
Return to the
Current Literature Review Front Page
[ see abstract below ]
The March-April 2000
edition of Regional Anesthesia and Pain Medicine has provided us
with an exhaustive review of the use of spinal analgesics. This review,
published by Mark Wallace and Tony Yaksh, extends over 30 pages and reviews
information gathered from 326 references. With the ongoing increase in the
utilization of intraspinal delivery systems, it is extremely valuable to
have a review of the history that led to the use of these medications and
their delivery within the spinal canal, as well as the outcomes and potential
problems that are associated with their administration. The first part of
the article is a historical section that outlines early spinal drug delivery.
They review various spinally delivered analgesic agents, including opioids,
 2-adrenergic
agonists, end-type voltage sensitive calcium channel blockers, NMDA (N-methyl-D-aspartate)
receptor antagonists, adenosine, cholingeric agonists, GABA agonists, and
combination spinal drug therapies. They examine the efficacy of long-term
spinal drugs, tolerance in intraspinal drug delivery, safety of spinally
delivered agents, and their outcomes. The authors then go on to describe
various intraspinal drug delivery techniques, including externalized systems,
partially externalized systems and fully internalized systems. There is
a discussion of the morbidity of chronically implanted systems, including
catheter-associated morbidity, neurologic complications, infection, fibrosis
malfunction, pump or port-pocket associated problems, and pump system associated
problems. There is also a brief discussion of patient selection, including
screening trial techniques and psychological screening. Finally, there is
a brief discussion of the economics of chronic spinal drug delivery for
analgesia.
These authors have provided an
extremely valuable contribution to the medical literature with their
review of the introduction and application of intraspinal drug delivery
systems. It is worthwhile reading for anyone who is interested in the
history of current state of intraspinal drug delivery for the management
of pain. I believe this article will find great utility as a reference
and a basis for understanding our current state of knowledge.
ABSTRACT
Long-term spinal analgesic delivery:
a review of the preclinical and clinical literature.
AUTHORS:
Wallace M, Yaksh TL
SOURCE:
Reg Anesth Pain Med 2000 Mar-Apr;25(2):117-57
[No abstract available]
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