| System | Advantages | Disadvantages |
|---|---|---|
| Percutaneous temporary catheter |
Used extensively both intraoperative and postoperatively. Useful when prognosis is limited (<1 month). |
Mechanical problems include catheter dislodgment, kinking, or migration. |
| Permanent silicone- rubber epidural |
Catheter 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 port |
Increased 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 reservoir | Potentially, 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. |
Transdermal
Nasal
Intravenous or Subcutaneous
Intraspinal
Intraventricular
Adjuvant Drugs
General comments and cautions regarding the use of opioid analgesics
Neuraxial Opioid Infusion
Index