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Management of the Patients with Spinal Cord Stimulators and Intrathecal Pumps 

Management of the Patients with Spinal Cord Stimulators and Intrathecal Pumps
Management of the Patients with Spinal Cord Stimulators and Intrathecal Pumps

Samuel W. Samuel

and Khodadad Namiranian

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date: 12 July 2020

Abstract: This chapter describes management of patients with intrathecal pumps, spinal cord stimulators, and other implanted devices used for treating chronic pain. Except for the intrathecal baclofen pump, all other implantable devices are used mainly for pain control; their cessation will not result in a life-threatening situation. The symptoms of baclofen overdose range from dizziness and drowsiness to respiratory depression, hypothermia, seizures, hypotonia, and coma. Symptoms of baclofen withdrawal range from seizures to muscle rigidity that advances to rhabdomyolysis, multiple organ failure, and death. Spinal cord stimulators can be turned off before a procedure and turned on at the end of it. Intrathecal pump infusion can be continued during the surgery and the postoperative pain regimen must be supplemented with other methods for analgesia. Implantable devices must be protected from electrocautery per manufacturer’s recommendation. Generally, MRI interferes with some spinal cord stimulators, but patients with intrathecal pumps can be exposed to MRI with strength of magnetic field up to 1.5 Tesla.

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