The
patient is admitted to hospital for a brief stay - the number
of days varying from one ITB centre to another. The operative
procedure usually lasts no more than two hours involving a general
anaesthetic.
Before the surgery it will be decided where the best position
of the pump should be for it to be comfortable, usually this
position is under the skin below the belt-line to one side of
the lower abdomen.
There are two choices of SynchroMed II pump differing in the
size of the drug reservoir, either 20 or 40 millilitres; the
choice depends on many factors including the size of the patient,
the anticipated daily dose of ITB, the estimated refill intervals
and the distance that the patient lives from the implanting and/or
refilling centre.
The pump can be implanted in different ways. Usually in patients
with good skin quality and adequate fat cover it is implanted
just beneath the skin in the subcutaneous fatty tissue which
lies above the abdominal muscles of the lower abdomen. However,
many patients are of low bodyweight and mass with little fat
cover. In these patients many surgeons have chosen to implant
the pump slightly deeper beneath a tough connective tissue called
fascia which surrounds the muscles. This “subfascial” (beneath
the fascia) placement in smaller, thinner patients provides a
better cosmetic appearance and less risk of potential skin problems
overlying the pump. The pump is connected to a small flexible
thin tube called a catheter which is tunneled beneath the skin
around the flank of the patient and into the intrathecal space containing the
cerebrospinal fluid (CSF) which cushions, bathes and nourishes
the spinal cord. It is usual for the pump reservoir to be partly
filled with ITB at the time of the implant so that the patient
can begin the therapy immediately.
Depending on the policy of the implanting centre, the patient
may need to remain in hospital for a few days to recover from
the operation during which time the pump is filled with ITB,
activated and the process of titrating the dose to find the correct
dosage begins. Once discharged from hospital it is important
that all the instructions of the medical team are followed including
adhering to the date of the next hospital appointment.
After the surgery, there will be some discomfort and tenderness
where the pump and catheter have been implanted. Often a course
of antibiotics are prescribed that require to be taken after
the operation to avoid infections. If any excessive redness,
swelling or soreness is noted around any of the wounds the medical
team must be notified.
The medical team may advise the patient to restrict their activities
for a few weeks after surgery to allow the implanted pump system
to “settle”. Once the wounds have healed the pump
site requires no special care. However it is recommended that
before any excessive or repetitive activities, such as sports
especially contact sports, are undertaken that advice on the
possible effects on the pump system are discussed with the medical
team. |
