Pumps for intrathecal drug delivery
Pompes: matériel et opération
Anatomie d'une pompe à morphine
Radiographie d'une pompe à morphine
Programmeur (ancien) pour pompe à morphine
Programmeur (nouveau) pour pompe à morphine
 
Pumps: instructions for patients
These instructions concern patients operated on by our team. Each center has its own treatment protocols and they may differ from the instructions below.
Preparation before the operation:
  • Anti-aggregating drugs like Aspirin or Plavix must be stopped 10 days before the date of the operation. However, you must make sure with your doctor or your cardiologist that this stop is not risky. If stopping is not possible, you should inform your surgeon and anesthesiologist to see if the planned operation is being continued on the scheduled date.
  • Anticoagulant drugs like Sintrom should be stopped 1 week before the date of the operation. Crossbreeding with heparin injections (eg Fraxiparine, Fragmin) will be performed under the supervision of your attending physician. A 60% PT is required for the procedure. However, you must make sure with your doctor or your cardiologist that this stop is not risky. Modern anticoagulant drugs like Xarelto should be stopped 2 days before the date of the operation. If a stop is not possible, you should inform your surgeon and your anesthesiologist to see if the planned operation is being continued on the planned date.
  • You should bring a list of your usual medications for the procedure. If your treatment is not common, consider taking the medicines themselves as well.
  • In the event of a known allergy , please inform the nursing team and the anesthesiologist even if it is already in your file. Certain allergies may require a specific allergological assessment and lead to postponement of the procedure.
Postoperative consequences:
 
  • During a first pump implantation or during a catheter revision, it is necessary to keep the position in bed on the back for 4 hours to facilitate hemostasis, then it is possible to turn on the side en bloc. For pump changes, you can adopt the position that suits you to minimize postoperative pain.
  • You must get up as a whole and the physiotherapist and / or the nurse will accompany you for the first awakenings. It is advisable to move your legs in bed before getting up to limit the risk of orthostatic hypotension (pressure drop when getting up).
Wound - scar:
 
  • The scar will be more beautiful if it is not exposed to the sun for 1 year after the operation. Remember to protect it either with clothes or with a total screen.
  • Steristrips should be kept until check-up 3 weeks postoperatively.
  • The threads are absorbable and do not have to be removed .
  • In case of discharge and / or fever , please call the secretariat immediately (021 923 3848) or in case of unavailability your attending physician, the hospital where you had the operation or the emergency department of a hospital near your home.
Medicines:
 
  • Usual drugs should be continued as before the operation, with the exception of narcotics. Narcotics (Tramal, Oxynorm, Targin, MST, Durogésic, ...) are not compatible with intrathecal morphine administered by the pump and are formally contraindicated outside a specialized environment .
  • Anti-aggregating drugs such as Aspirin or Plavix can be resumed the day after the operation.
  • Anticoagulant drugs such as Sintrom can be resumed as early as 2 days after the operation. The same goes for modern blood thinners like Xarelto.
  • Non-narcotic analgesics (Dafalgan, Irfen, ...) should only be taken in the event of pain; they are not compulsory and do not influence healing in the proper sense.
  • Great care should be taken with all drugs with a primary or secondary sedative effect, as the sedative effect is potentiated by the intrathecal morphine administered by the pump. Usual doses can therefore lead to deep sedation or even coma. The intake of medication from the following categories should be discussed with your specialist:

    - Sleeping pills (Seresta, Temesta, Stilnox ...)
    - Antidepressants (Sarotene, ...)
    - Neuroleptics (Nozinan, Haldol, ...)
    - Antiepileptics (Lyrica, Neurontin, Trileptal, Rivotril, ...)
    - Muscle relaxants (Sirdalud, ...)
    - Antihistamines (Zyrtec, ...)
Return home: In addition to this, you need to know more about it.
  • Please check that you have enough medication at home for the day of your return, especially before a weekend or holiday.
  • Please check that you have received (if necessary):
    • prescription for pain medication
    • the prescription for physiotherapy (not systematic)
    • the order for the caregiver at home (make contact before the intervention)
    • work stoppage
    • the date and time of the next check-up
Physical activities and side effects of treatment:
 
  • Walking is the best physical activity. . It is however preferable to privilege the frequency to the duration. Thus, it is generally better supported to walk 4 x 15 minutes per day rather than going for an hour-long walk per day.
  • Heels between 1 and 4 cm are most suitable for the back, but have no direct effect on drug delivery by the pump.
  • You must respect the limits dictated by your body , because an excess of activity one day almost always leads to a limitation of the activity on the following days with a negative overall balance.
  • The effect of intrathecal morphine depends on the position of the body. The central side effects (drowsiness, nausea, vomiting, confusion, ...) are increased when lying down and reduced when standing. If these side effects are present, it is therefore necessary to avoid the natural reflex of wanting to lie down and to prefer sitting or walking.
  • Intrathecal morphine can cause intense itching when starting treatment (direct histamine-liberating effect). This side effect goes away quickly and should be trivialized.
  • Intrathecal morphine can cause a urinary balloon when starting treatment. If you have difficulty urinating, you should go to a doctor who can perform a urinary catheterization if necessary (for example a medical clinic)
  • Morphine slows down transit and thus promotes constipation (although this side effect is less marked in intrathecal administration). This side effect should be compensated for by:
    - frequent walking
    - good hydration
    - a diet rich in fiber
Sport:
 
  • Resuming sports activities should not cause the onset or increase of pain, but early resumption is desirable so as not to lose too much muscle.
  • Brisk walking remains the best sport activity. In case of balance disorders or subjective insecurity, the use of Nordic walking poles is recommended.
  • Swimming is possible, but only after a period of one week after the removal of the threads and provided that the wound has healed normally.
  • Running is possible from 1 month, but avoiding asphalt. Prefer running in the forest or on a Finnish track, for example.
  • Downhill skiing or snowboarding is possible between 1 and 3 months.
  • Snowshoeing is excellent and can be started after 1 month.
  • The bike can be picked up within one month of the operation.
Job:
 
  • You are at least on complete sick leave until the postoperative check-up at 3 weeks, then according to your assessment.
  • As a general rule, the average duration of complete sick leave for this type of intervention is 1 to 2 months. A part-time recovery usually follows this period of total stoppage.   
Transport:
 
  • Car trips should not exceed 30 consecutive minutes in the 1st month. If a longer trip is required, take a break after 30 minutes and walk at least 10 minutes during this break. A longer journey is not only painful, but it increases the risk of deep vein thrombosis (which is already temporarily increased by the operation).
  • The most suitable means of transport is the train . The bus and the plane are possible and better supported than the car.
  • When a journey is feasible on foot, do not take the car!
Night:
 
  • The prone position is not well tolerated and is not recommended.
  • The recommended type of mattress is either very hard or "memory" type Tempur
  • While lying on the back, it is necessary to put a cushion under the knees to avoid lumbar hyperlordosis and while lying on the side, it is necessary to put a cushion between the knees to prevent rotation of the pelvis.
      
Radiological examinations:
 
  • Your intervention does not contraindicate any subsequent radiological examination. X-rays, a CT-scan or an ultrasound are perfectly possible in the event of a medical indication. No special precautions are necessary for these radiological examinations. For an MRI, it is recommended to empty the pump beforehand and to fill it with physiological solution even if theoretically the pump supports the MRI well. We must therefore synchronize the examination with 2 visits to our center (to empty, then to refill the pump)
       
Physiotherapy:
 
  • Physiotherapy is prescribed by a doctor and is not normally required for such an operation.
  • In most cases, we assess its indication for control at 3 weeks after the operation.
  • Whenever possible, choose a physiotherapist near your home to avoid a car trip to get there.
    .
Various:
 
  • It is possible to shower with the special dressing that has been applied, but it should be dried well by dabbing afterwards. Do not rub so as not to peel off the dressing and steristrips.
  • It is best to wait 4 days after removing the dressing to take a bath.
  • Driving a vehicle is possible for usual doses of intrathecal morphine, but you must first have found your cruising dose. It is therefore not recommended to drive the first 3 months. When resuming driving, you should test your ability to drive in an empty parking lot. In case of doubt, you must consider yourself unfit to drive until a medical examination giving the green light.
  • It is possible to resume sex as soon as you get home, but it is better to make your partner work.