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Table 4. Advantages and Disadvantages of Intraspinal Drug Administration

System  Advantages  Disadvantages 
PCA = patient-controlled analgesia.
Percutaneous temporary catheterUsed extensively both intraoperatively and postoperatively.Mechanical problems include catheter dislodgment, kinking, or migration.
Useful when prognosis is limited (<1 month).Increased risk of infection.
Permanent silicone-rubber epiduralCatheter 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 portIncreased stability, less risk of dislodgment.Implantation more invasive than external catheters.
Can deliver bolus injections or continuous infusions (with or without PCA).Approved only for epidural catheter in United States.
Potential for infection increases with frequent injections.
Subcutaneous reservoirPotentially reduced infection in comparison with 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.