Reduserer snittføringen ved implantasjon av bakflofenpumpe sensibiliteten over påfyllingsporten?

Abstract

Abstract

Bakground Knowledge: Baclofen pump treatment is used with patients with spasms and spasticity. The pump is implanted subcutaneous on the abdomen, and a spinal catheter continuously delivers the medication to the cerebrospinal fluid. Current practice is to implant the pump with an angular incision.

Hypothesis: In this project we have examined patients with a baclofen pump with a view to the impact of the incision to the sensibility over the pump. Our hypothesis was that the angular incision cut through nerves in the skin, so that the sensibility to stings over the skin area punctured while filling the pump was reduced, which would lead to less discomfort for the patients when filling-up.

Material and Method: We examined patients who came for a routine check-up at the neurological policlinic at Rikshospitalet. All the patients were asked to participate in the study, 9 was excluded, 7 declined, and 23 were included in the study. The patients’ sensibility was examined for 3 modalities; temperature, touch, and sting. We examined proximally and distally around the incision, in addition to the opposite side of the stomach/abdomen in order to have a reference sensibility.

Results: Only 6 patients had the sensibility outcome that we had expected they would get, with a clear reduced sensibility distally by the incision. The remaining either had unchanged sensibility or loss of sensibility that could not be related to the incision.

Discussion: The patients’ diagnosis and time of implantation were dissimilar, however, we did not find a correlation between the different results and the different diagnoses or time of surgery. The peripheral neurones have a considerable ability of regeneration. This could indeed help explain that the cutting of the nerves in the skin during surgery seems to be of limited value.

Conclusion: Our conclusion is that the value of the angular incision seems to be limited and that one should adjust the incision to each patient’s wishes, needs and anatomy.