Upper Antero-Medial Thigh as an Alternative Site for Implantation of Intrathecal Pumps: A Case Series

The Polyanalgesic Consensus Conference (PACC)®: Intrathecal Drug Delivery Guidance on Safety and Therapy Optimization When Treating Chronic Noncancer Pain

INTRODUCTION

The International Neuromodulation Society convened a multispecialty group of physicians and scientists based on expertise with international representation to establish evidence-based guidance on intrathecal drug delivery in treating chronic pain. This Polyanalgesic Consensus Conference (PACC)® project, created more than two decades ago, intends to provide evidence-based guidance for important safety and efficacy issues surrounding intrathecal drug delivery and its impact on the practice of neuromodulation.

MATERIALS AND METHODS

Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when PACC® last published guidelines) to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence is scant.

RESULTS

The PACC® examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process.

CONCLUSIONS

The PACC® recommends best practices regarding intrathecal drug delivery to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.

Alternative Implantation Site of Intrathecal Pump in the Submuscular Plane of the Pectoralis Major Muscle: A Case Report

An intrathecal drug delivery system (IDDS) has been widely utilized in the management of chronic pain and spasticity when oral pharmacologic agents are deemed ineffective. Typically, intrathecal pumps are implanted in the abdominal region; however, previous case reports have described nontraditional pump implantation sites, such as anterior thigh, gluteal region, and iliac fossa. Adding to the growing literature of alternative implantation sites, this case report discusses the implantation of the pump into the submuscular plane of the pectoralis major muscle and reviews the advantages and disadvantages of this location.