Implanted intrathecal drug delivery systems: a narrative review for the perioperative, obstetric, and intensive care anesthesiologist.

Abstract

Patients with implanted intrathecal drug delivery systems (IDDS) present unique challenges for anesthesiologists in the perioperative, peripartum, and intensive care settings. A comprehensive and practical review on this topic is needed. This narrative review highlights essential knowledge required for safe management of this patient population, including familiarity with: (1) IDDS technology and therapeutics; (2) the appropriateness of neuraxial procedures in IDDS patients; and (3) IDDS-related complications in the operating room and intensive care unit. A literature search was conducted using PubMed/MEDLINE and Google Scholar with the following keywords: intrathecal pump, intrathecal drug delivery, intrathecal morphine, perioperative medicine, labor anesthesia, regional anesthesia, and intrathecal baclofen. Reference lists of relevant articles were manually screened to identify additional pertinent studies, case series, and case reports. Intrathecal pump device manuals were also reviewed to obtain technical details. Based on the available evidence, we provide background medical knowledge and guidance regarding IDDS across five main sections: intrathecal pharmacology, considerations related to IDDS implantation, perioperative care of patients with IDDS, neuraxial anesthesia, and device-related safety concerns. In each section, we summarize available literature and provide contextual interpretation informed by expert opinion when evidence is limited. This review provides a comprehensive overview of current best practices for the perioperative management of patients with IDDS, emphasizing evidence-based approaches to optimize clinical outcomes and ensure patient safety. Key topics covered include intrathecal medications, their performance under MRI, and precautions prior to attempting any neuraxial access in patients with IDDS.