A report on the consequences of the first implanted device for long-term analgesia in refractory XXXX .

@entity5 @entity1 @entity158
BACKGROUND: During the early 1970s, satisfactory long-term treatment of the severe @entity158 associated with @entity5 was not available. Spinal cord stimulation introduced a few years earlier in 1967 had not proven to be effective in treating @entity158 . We describe our pioneering experience using an implanted device to infuse local anesthetics into the epidural space and provide @entity158 relief to the @entity1 . METHODS: Increasing doses of systemic opioids were unsuccessful in treating the intractable @entity158 of spinal metastases in our @entity1 . We devised an analgesic delivery system by modifying equipment usually used for ventriculoperitoneal shunts. A lumbar epidural catheter was inserted in the @entity1 's spine, then tunneled subcutaneously across the flank to the anterior abdominal wall, and subsequently connected to a modified Ommaya reservoir with ventriculoperitoneal shunt tubing. This was filled with local anesthetic and injected into the @entity1 's epidural space by manual compression. RESULTS: The system was used for several months with intermittent addition of local anesthetic to the reservoir with satisfactory control of the @entity1 's @entity158 . CONCLUSIONS: We describe the first use of an implanted epidural catheter system for long-term relief of @entity158 due to @entity5 that occurred at Peter Bent Brigham Hospital in Boston. We contend that this event played an important role in the cascade of devices that followed and connect it to the changes in the attitude of health care providers toward treatment of @entity5 .
