Table 6. Advantages and disadvantages of intraspinal drug delivery systems

SystemAdvantagesDisadvantages
Percutaneous temporary catheterUsed extensively both intraoperative and postoperatively. Useful when prognosis is limited (< 1 month).Mechanical problems include catheter dislodgment, kinking, or migration.
Permanent silicone-rubber epiduralCatheter implantation is a minor procedure. Dislodgment and infection less common than with temporary catheters. Can deliver bolus injections, continuous infusions, or PCA (with or without continuous delivery).
Subcutaneous implanted injection portIncreased stability, less risk of dislodgment. Can deliver bolus injections or continuous infusions (with or without PCA).Implantation more invasive than external catheters. Approved only for epidural placement in U.S. Potential for infection increases with frequent injections.
Subcutaneous reservoirPotentially, reduced infection in comparison to external system.Difficult to access, and fibrosis may occur after repeated injection.
Implanted pumps (continuous and programmable)Potentially, decreased risk of infection.Need for more extensive operative procedure. Need for specialized equipment with programmable systems.

From: 9, Management of Cancer Pain: Adults

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