Spinal Cord Stimulation Medication

Updated: Jan 07, 2015
  • Author: Anthony H Wheeler, MD; Chief Editor: Kim J Burchiel, MD, FACS  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Benzodiazepines

Class Summary

These agents depress all levels of the central nervous system (eg, the limbic and reticular formations), possibly by increasing the activity of gamma-aminobutyric acid (GABA). Benzodiazepines also increase the frequency of chlorine channel opening in response to GABA binding. GABA receptors are chlorine channels that mediate postsynaptic inhibition, resulting in postsynaptic neuron hyperpolarization. The final result is a sedative-hypnotic and anxiolytic effect.

Benzodiazepines have been used in children for various indications, including the reduction of anticipatory or acute situational anxiety. Note the importance of using caution, and use these drugs only in conjunction with psychotherapy aimed at reducing the length of time on benzodiazepines.

Alprazolam (Xanax, Niravam)

Alprazolam binds receptors at several sites within the central nervous system (CNS), including the limbic system and reticular formation. Effects may be mediated through the gamma-aminobutyric acid (GABA) receptor system. It has a short half-life (< 12 h).

Lorazepam (Ativan)

Sedative hypnotic with short onset of effects and relatively long half-life. By increasing the action of GABA, a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation. Excellent choice when patient must be sedated for longer than 24 h.

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Antibiotics, Other

Class Summary

Empiric antimicrobial therapy should cover all likely pathogens in the context of this clinical setting. The administration of oral or parenteral prophylactic antibiotics 30-120 minutes before the procedure has been advocated.

Cefuroxime (Ceftin, Zinacef)

Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity of first-generation cephalosporins; it adds activity against Proteus mirabilis, Haemophilus influenzae, E coli, Klebsiella pneumoniae, and Moraxella catarrhalis.

Cefazolin

First-generation semisynthetic cephalosporin that by binding to 1 or more penicillin-binding proteins arrests bacterial cell wall synthesis and inhibits bacterial replication. Poor capacity to cross blood-brain barrier. Primarily active against skin flora, including S aureus. Regimens for IV and IM dosing are similar. Primarily active against skin flora, including S aureus. Typically used alone for skin and skin-structure coverage.

Clindamycin (Cleocin)

Clindamycin is a lincosamide is effective against aerobic and anaerobic streptococci (except enterococci). Clindamycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl transfer ribonucleic acid (tRNA) from ribosomes, causing RNA-dependent protein synthesis to arrest.

Vancomycin

Vancomycin acts by inhibiting proper cell wall synthesis in gram-positive bacteria. It is indicated for the treatment of serious infections caused by beta-lactam–resistant organisms and in patients who have serious allergies to beta-lactam antimicrobials.

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Local Anesthetics, Amides

Lidocaine (Xylocaine)

Lidocaine 1-2% is used. Lidocaine is an amide local anesthetic used in 1% concentration. The 1% preparation contains 10 mg of lidocaine for each 1 mL of solution. Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels. Following application of 1% lidocaine without epinephrine or preservative, skin and subcutaneous analgesia is achieved.

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