Intrathecal administration
Subarachnoid space | |
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Details | |
Identifiers | |
Latin | Spatium subarachnoideum, cavum subarachnoideale |
Anatomical terminology |
Intrathecal administration is a
The route of administration is sometimes simply referred to as "intrathecal"; however, the term is also an adjective that refers to something occurring in or introduced into the
Intrathecal administration of analgesic agents
This section may be confusing or unclear to readers. (March 2024) |
- Very popular for a single 24-hour dose of analgesia (opioid with local anesthetic)
- Caution because of late onset hypoventilation due to intrathecal opioids
- Severe pruritus and urinary retention may limit the use of intrathecal morphine
- Pethidine has the unusual property of being both a local anaesthetic and opioid analgesic which occasionally permits its use as the sole intrathecal anaesthetic agent
- An intrathecal catheter and pump can be used to deliver a local anaesthetic and sometimes also an opioid and/or clonidine.
- The analgesic ziconotide is administered through an intrathecal pump system.
Intrathecal administration of antifungal agents
For CNS infections, amphotericin B is administered intrathecally.[3]
Intrathecal chemotherapy
- Currently, only four agents are licensed for intrathecal chemotherapy:
- Methotrexate, cytarabine (Ara-C), hydrocortisone, and, rarely, thiotepa.[4]
- Accidental administration of any vinca alkaloids—especially vincristine but also vinblastine, vinorelbine, or others—via the intrathecal route is nearly always fatal.[5][6][7]
Intrathecal baclofen
Often reserved for spastic cerebral palsy, intrathecally-administered baclofen is done through an intrathecal pump implanted just below the skin of the abdomen (or behind the chest wall, depending on the surgeon implanting the device, and patient preferences), with a tube (called the 'catheter') connected directly to the base of the spine, where it bathes the spinal cord using a dose about one thousand times smaller than that required by orally-administered baclofen. Intrathecal baclofen also carries none of the side effects, such as sleepiness, that typically occur with oral baclofen. However, intrathecal baclofen pumps carry serious clinical risks, such as infection or a possibly fatal sudden malfunction, that oral baclofen does not.
A tremendous amount of care is taken to ensure the optimal location of the pump and catheter, based upon medical considerations and patient requirements.
See also
- Cancer pain/Interventional/Intrathecal pump
- History of neuraxial anesthesia
- Intrathecal pump
- Theca
- Thecal sac
References
- ^ "Route of Administration". Data Standards Manual. Food and Drug Administration. Retrieved 11 March 2011.
- S2CID 34995402.
- PMID 32349999.
- PMID 8445432.
- PMID 15378106.
- PMID 17355029.
- ^ International Medication Safety Network (2019), IMSN Global Targeted Medication Safety Best Practices, retrieved 2020-03-11.