ziconotide and Urinary-Bladder-Neoplasms

Intrathecal ziconotide is used for the treatment of chronic pain and is delivered by an implanted drug delivery device. Anesthesiologists should be familiar with the perioperative management of the pump as well as the potential adverse events related to continued ziconotide infusion during general anesthesia. A case is presented demonstrating the perioperative management of an intrathecal drug delivery device infusing ziconotide in a patient presenting for radical cystectomy with pelvic lymphadenectomy and ileal conduit diversion.

Topics: Aged; Analgesics, Non-Narcotic; Anesthesia, General; Carcinoma, Transitional Cell; Chronic Pain; Cystectomy; Deprescriptions; Humans; Infusion Pumps, Implantable; Infusions, Spinal; Intraoperative Complications; Low Back Pain; Lymph Node Excision; Male; omega-Conotoxins; Pelvis; Perioperative Care; Urinary Bladder Neoplasms; Urinary Diversion; Vasoplegia

The omega-conopeptide, ziconotide, is an N-type calcium-channel blocker that has been shown to produce antinociception in animals using formalin and hot-plate tests. Initial reports of intrathecal administration of ziconotide in cancer and AIDS patients whose pain was unrelieved with opioids demonstrated analgesic efficacy. Although adverse effects were reported, these appeared to be easily managed through dose reduction or symptomatic treatment. This clinical report describes the experiences of three patients with serious adverse effects associated with intrathecal ziconotide.

Topics: Ataxia; Back Pain; Calcium Channel Blockers; Confusion; Humans; Hypotension, Orthostatic; Injections, Spinal; Male; Middle Aged; Multiple Sclerosis; Nystagmus, Pathologic; omega-Conotoxins; Pain; Urinary Bladder Neoplasms