Preparation for the Surgery
1. Sterilization Procedures
You may be asked to take a shower with pHisoHex before you arrive at the hospital. This is done to reduce the risk for staph infection and inflammatory granuloma. There are some guidelines to follow and risks associated with the use of pHisoHex, so listen carefully to your doctor's instructions.
2. Determining the Pump's Location
Before the procedure, you will speak with the surgeon to determine the location of the pump. It will be somewhere in your abdominal region, but you have input in this decision. Prepare for this conversation by thinking about your clothes and belts. Drug pumps come in a number of sizes. If you are overweight in the stomach area, the surgeon may be able to reinforce the pump to help stabilize its position. In this case, you may have to wear an ace bandage around your abdomen for the first few days after surgery. To learn more, ask your doctor about your options.
3. Preventing Infection
It is possible you will be given an antibiotic as a precaution to help prevent infection.
4. Anesthesia
You may be given either general anesthesia or IV sedation. "It's not an extensive surgery, so the I.V. sedation generally works fine," says Dr. Sudhir Diwan, director of the Pain Medicine division at Weil-Cornell Medical College.
During the Procedure
The surgery will take place with you lying on your side, to give the surgeon access to your back for inserting the catheter, and your abdomen for implanting the pump.
The implantation generally takes between 1 to 3 hours. If you have a longstanding chronic back problem, as many pump patients do, you may have scoliosis or scar tissue. In that case the implantation may take longer as the doctor has to work out the details of inserting the catheter properly.There are two main steps to the permanent implantation procedure. The first is to insert the catheter into the back and the second is to implant the pump in the front (and connect the catheter tube to the pump). Appropriate placement of the catheter requires manual dexterity on the part of the surgeon, along with an in-depth knowledge of the anatomy of the spinal cord.
Next, the pump is prepared for placement into your abdomen. The doctor will fashion a "pocket" under the skin for housing the pump. The type of pump -- i.e., constant flow or programmable -- determines the complexity of this part of the procedure.
See Page Three for information on follow-up care:
