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Interventional Pain Management Spinal anatomy and Intrathecal Drug Delivery Amitabh Gulati MSKCC Dept. of Anesthesiology and Critical Care
Objectives ,[object Object],[object Object],[object Object]
 
The Spine
The Spinal Cord
Cord anatomy
Cord anatomy
The Rexed lamina ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Ascending Spinosensory tracts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Descending inhibition ,[object Object],[object Object],[object Object],[object Object],[object Object]
Brachial plexus
Lumbar plexus
Sacral Plexus
The Autonomic Nervous System
Visceral innervation
 
Intraspinal techniques Permanent Epidural, DuPen Intratehcal implantable pump
Opiate receptor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opiate effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epidural administration ,[object Object],[object Object],[object Object],[object Object],Bernards et al. Anesthesiology 2003 Epidural Spread Intrathecal spread
Epidural Opiates ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bernards et al. Anesthesiology 2003
Spinal opiates ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Distribution of morphine ,[object Object],[object Object],[object Object],[object Object],[object Object],Flack et al. A&A 2011
Intrathecal opioids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intrathecal bupivacaine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clonidine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ziconotide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Baclofen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Consensus maximum doses
Consensus algorithm
The Controversy of Trialing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dose Conversions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epidural trial ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The CSE trial ,[object Object],[object Object]
Tips to convert to IT pump ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
An example ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Continued ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
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Spinal anatomy and_intrathecal_drugs