• Neuromodulation · Oct 2019

    Review

    Intrathecal Gadolinium Use for the Chronic Pain Physician.

    • Jonathan M Hagedorn, Markus A Bendel, Susan M Moeschler, Tim J Lamer, Jason E Pope, and Timothy R Deer.
    • Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
    • Neuromodulation. 2019 Oct 1; 22 (7): 769-774.

    IntroductionThe approach to intrathecal (IT) drug delivery malfunction is complicated, particularly for iodine-allergic patients. In these situations, the current literature has not addressed the use of IT gadolinium. Case reports exist showing severe neurotoxic manifestations with IT gadolinium use. We sought to provide a resource for chronic pain physicians treating an iodine-allergic patient and considering the use of IT gadolinium.MethodsA thorough literature search identified 11 published cases of gadolinium-induced neurotoxicity due to IT injection and those cases are described in detail. The literature was also reviewed for safe dosages of IT gadolinium.ResultsAfter thorough review, a safe IT gadolinium dose is provided. Additionally, an algorithm was developed for the workup of an IT pump malfunction in iodine allergic patients.ConclusionHerein, we provide guidance on IT gadolinium usage and a framework for IT pump malfunction in iodine allergic patients.© 2019 International Neuromodulation Society.

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