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What is it?
Morphine pump implantation is a surgical procedure performed to permanently implant a pump that delivers morphine to the spinal fluid to treat chronic pain.
What is its goal?
The aim of the operation is to implant a pump that will deliver morphine to the spinal fluid for the treatment and relief of pain. This sometimes avoids some of the side effects encountered with very high doses of narcotic pain medication like morphine.
How is it done?
During a pre-operative trial, morphine is injected into the spinal canal (using a small needle) and you are assessed by the treatment team over several hours to determine how well the medicine treats the pain. If a positive effect is observed then you may be a candidate for implantation of a permanent pump to delver the drug.
The pump is inserted under the covering of the abdominal muscles while the patient is under a general anesthetic. A small catheter is then inserted through a needle into the spinal fluid space and is threaded upward. The catheter is then tunneled under the skin to the abdomen and is connected to the pump. The pump is filled with the drug morphine and is programmed by a computer to continuously release a specified dose that is determined by the physician.
The operation is completed when the incision is closed with suture material (stitches) or surgical staples. If the outer incision is closed with staples or non-absorbable sutures, they will have to be removed after the incision has healed. The procedure usually lasts 1-2 hours.
What are the risks?
There are always risks with any surgery. Potential complications may include:
- Pain, numbness, weakness or paralysis due to nerve damage (rare)
- Cerebrospinal fluid leak
- Recurrence or continuation of pain.
- Bleeding/injury to blood vessels
- General anesthetic complications
Hardware related complications during surgery is rare but can include catheter migration. After surgery though, the potential hardware complications include: catheter fracture or migration, infection or pump malfunction.
What is the success rate?
The success rate of morphine pump implantation for delivery of morphine to the spinal fluid is generally favorable. Patients tend to have had a good response with their pain control in pre-operative trials. This is the permanent implantation phase.
How long will I stay in the hospital?
After the surgery, patients are in the hospital for a few days. Each individual patient's return to normal activity is largely dependent on his/her pre-operative condition and age. Typically you will be able to go home once your vital signs are stable, you can walk on your own, you can eat without having nausea, and you have resumed normal bladder activity. Follow-up will be needed as the pump will need to be refilled every couple of months, depending on the pump size, concentration and dose. Refills are done in the office using a syringe and needle and take approximately fifteen minutes to complete. At that time, morphine doses are adjusted depending on the effects that are being seen.