The use of combined spinal–epidural technique to compare intrathecal ziconotide and epidural opioids for trialing intrathecal drug delivery

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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.

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