More conservative treatment options have failed, or other options are unacceptable or not indicated. A trial of neuraxial medications provides acceptable pain relief, tolerable side effects, and functional improvement, when…
Agent Starting dose Morphine 0.1–0.5 mg/day Hydromorphone 0.02–0.5 mg/day Fentanyl 25–75 μg/day Bupivacaine 1–4 mg/day Clonidine 40–100 μg/day Ziconotide 0.5–2.4 μg/day From Deer et al. (2012) with permission Table 41.2…
Fig. 32.1 Frame-based stereotactic guidance for deep brain lead placement (left). Frameless stereotactic guidance for deep brain lead placement (right) Stereotactic localization of bilateral entry points is performed and these…
Year Milestone 1885 Leonard Corning administers neuraxial local anesthetic 1901 Intraspinal morphine use is first reported 1935 Dr. Grafton Love first proposes continuous catheter access 1940 The first practical application…
Fig. 20.1 Intraoperative view of thoracic paddle lead implantation. (a) The electrode is behind the body of T9 and T10. Stimulation is right sided with the cathode at the second…
Fig. 25.1 Stimulation strategies: tonic stimulation 40 Hz (a); burst stimulation (b) It is important to briefly comment on the mechanism of action, as Burst-SCS appears to work differently than…
Fig. 21.1 Bilateral pelvic stimulation (left) with 3.8-mm quadripolar, selective, cephalocaudal paddles (S1 laminotomy). Distal contacts are anodes at each S2 foramen, and the proximal three contacts are each cathodes….
Fig. 24.1 Radiograph of correct lead placement at vertebral levels T8 to T11, the “sweet spot.” The trial leads can be placed through a needle and then secured to the…
Advancement Current use Future impact Rechargeable IPG Yes Large Enhanced battery life No Important for smaller IPG Different targets Yes Important for DRG-SCS Increased frequency Yes Makes miniaturization difficult Bluetooth…
Patient factor Adverse impact on healing Age Extremes of aged and youth Weight Extremes of obesity and cachexia Nutrition Negative protein balance Blood supply Ischemia and edema Immune function Immunosuppression…
