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The Intrathecal Drug Administration System (ITDAS) can be an effective treatment option for patients with chronic pain. However, as with all medical interventions, it is not without potential complications. Since ITDAS involves implanting a device within the patient’s body and requires drug refills at least every three months, it carries the risk of iatrogenic adverse events. One such complication arises when the reservoir fill port is not accurately located during the refill procedure. In such cases, the medication may not be properly delivered into the device and can instead accumulate in the subcutaneous tissue. This misadministration, particularly involving opioids, can lead to various adverse effects depending on the specific drug used. Morphine, the most commonly used opioid, may cause overdose symptoms such as nausea, vomiting, pruritus, urinary retention, constipation, and edema. Less commonly, it may result in serious complications like respiratory depression. To avoid these risks, the use of ultrasound during the ITDAS refill procedure is essential. Ultrasound guidance ensures that the needle is correctly inserted into the reservoir fill port and allows verification of residual drug aspiration. If aspiration cannot be confirmed, the refill process should be halted and the needle position should be reassessed to ensure patient safety.