title: The use of combined spinal-epidural technique to compare intrathecal ziconotide and epidural opioids for trialing intrathecal drug delivery.
abstract: SUMMARY Choosing the initial medications for intrathecal delivery is often confusing and not standardized. We describe a novel way for using a combined spinal-epidural technique to compare two first-line medications for intrathecal delivery; ziconotide and morphine (or hydromorphone). Five patients with intractable chronic or cancer pain were elected to have an intrathecal drug delivery system implanted for pain management. Each patient was given a 3-day inpatient trial with the combined spinal-epidural technique. The Visual Analog Scale, Numerical Rating Scale, short-term McGill questionnaire and opioid consumption were monitored daily. The results were used to develop a paradigm to describe how ziconotide can be used in practice.
authors.affiliation: Department of Anesthesiology & Critical Care, Memorial Sloan-Kettering Cancer Center M308, New York, NY 10065, USA.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Gulati
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Loh
authors.forename: Vinay
authors.initials: V
authors.lastname: Puttanniah
authors.forename: Vivek
authors.initials: V
authors.lastname: Malhotra