There have been numerous recommendations for a starting dose of intrathecal ziconotide. The therapy remains underutilized partially due to reports of inefficacy and/or intolerance. This study describes short-term outcomes of a high-volume, low-concentration bolus (HVLC-B) ziconotide starting dose technique for patients with chronic spine pain. Intrathecal pumps are available with a Patient Therapy Manager (PTM), or patient-controlled intrathecal bolus device. Commonly published recommendations for a bolus dose has been 10% of the daily dose. This article describes an inversion of the traditional 10% rule-of-thumb. This article describes using the basal rate at a lowest programmable dose and utilizing the bolus for the majority of the medication delivery. Such an inversion may be considered a high volume bolus. The lowest commercially available concentration of ziconotide from the manufacturer is 25 mcg/mL. Pope and Deer (Neuromodulation, 18, 414–420 [2015]) described use of a dilution down to 5 mcg/mL. For purposes of this article, such dilutions to one-fifth of the commercially available solution are considered sufficiently dilute to qualify for the term “low concentration.” Furthermore, the patients in this analysis received dilutions down to one-fiftieth of the lowest commercially available solution.

中文翻译：

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齐考诺肽大容量、低浓度推注起始剂量技术的短期结果：病例系列

对于鞘内注射齐考诺肽的起始剂量有很多建议。部分由于无效和/或不耐受的报道，该疗法仍未得到充分利用。本研究描述了高容量、低浓度推注 (HVLC-B) 齐考诺肽起始剂量技术对慢性脊柱疼痛患者的短期结果。鞘内泵可与患者治疗管理器 (PTM) 或患者控制的鞘内推注装置一起使用。通常公布的推注剂量建议是每日剂量的 10%。本文描述了传统 10% 经验法则的倒置。本文描述了在最低可编程剂量下使用基础速率并在大部分药物输送中使用推注。这种倒置可以被认为是高容量推注。制造商提供的最低市售齐考诺肽浓度为 25 mcg/mL。教皇和鹿 (Neuromodulation , 18, 414–420 [2015]) 描述了使用低至 5 mcg/mL 的稀释液。就本文而言，此类稀释至市售溶液的五分之一被认为已足够稀释以符合术语“低浓度”的要求。此外，该分析中的患者接受了稀释至最低市售溶液的五十分之一。