[Hygienic relations and stability of drugs in peridural long-term infusion with implanted or external pumps]

Implantable devices (implanted pump/implanted catheter and port) are recommended for continuous epidural application of opiates or local anaesthetics in order to reduce hygienic problems during long term epidural medication. No signs of contamination could be found during bacteriologic culture of residual volumes of 30 patients treated with epidural drug delivery systems and of samples collected during an in vitro investigation (incubation of filled external pump systems at body temperature/storage of syringes with a premixed solution of opiate and local anaesthetic for repeated epidural bolus application). As demonstrated in a case report prophylactic antibiotic coverage prior to implantation may be necessary in patients with a preexisting susceptibility to infection. The concentrations of morphine (radioimmuno-assay) and of bupivacaine (gas-solid chromatography) within the reservoir were stable during clinical therapy as well as during the in vitro experiments.