Complications of Intrathecal Baclofen Pump: Prevention and Cure

Awaad, Yasser M.; Rizk, Tamer; Siddiqui, Iram; Roosen, N.; McIntosh, K.A.; Waines, G. Michael

doi:10.5402/2012/575168

Cited by 69 publications

(61 citation statements)

References 14 publications

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“…7,8 However, this result significantly differed in the 2 groups of patients in which the pump was implanted using different techniques (subcutaneously or under the fascia) and with a different preoperative prophylaxis protocol. The subfascial position resulted in a more protected site that appeared to prevent the risk of infection and skin ulceration, usually one of the first signs of infection in very slim children.…”

Section: Infectionsmentioning

confidence: 59%

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Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience

Motta¹,

Antonello²

2014

PED

112

102

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Object This single-center study investigated adverse events that occurred in children and adolescent patients treated with intrathecal baclofen (ITB) therapy for spasticity and/or dystonia. Methods In a 14-year period, 430 consecutive patients with a mean age of 13.3 ± 5.9 years received ITB over a mean follow-up period of 8.6 ± 3.8 years (range 12 months to 14 years). Eighty-nine percent of these patients had cerebral palsy. Major complications, defined as those that required a surgical intervention, were infections, CSF leaks, and device problems related to the catheter or pump. Assessing infections, the authors compared the 2 groups of patients implanted with an ITB system by either the subcutaneous or subfascial technique. The temporal distribution of events related to the catheter was also considered. Results At least 1 complication was present in 25% of the patients: 9.3% experienced an infection, 4.9% a CSF leak, 15.1% a problem with the catheter, and 1% a problem related to the pump. Five percent of the assessed patients suffered more than 1 complication. The rate of infections was significantly lower (p < 0.001) in patients with the pump placed subfascially compared with those with the pump placed subcutaneously. A higher rate of infection was found after pump replacement compared with the first pump implantation (10.6% vs 6%, respectively). Catheter problems were the most common complication and occurred more frequently during the 1st year after the implant. Conclusions While ITB is an effective treatment to manage spasticity of different origins, adverse events may occur and need to be managed. The surgical procedure should be meticulous and different techniques may have a diverse impact on the infection rate, which is the most critical complication. Despite the adverse events that occurred in this study, the majority of patients were satisfied with the treatment received.

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Section: Infectionsmentioning

confidence: 59%

“…7,9,17 The analysis revealed that the majority of events occurred during the first 12 months after the implant, while the number of patients with a complication related to the catheter decreased in the following years. This might be explained by the fact that a certain time interval is required before the catheter is stabilized.…”

Section: Catheter Problemsmentioning

confidence: 99%

Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience

Motta¹,

Antonello²

2014

PED

112

102

View full text Add to dashboard Cite

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“…[1,2,5,6] Initially, we suspected it to be seroma, so just a compressive dressing was applied. We avoided aspiration fearing that it may introduce infection.…”

Section: Discussionmentioning

confidence: 99%

“…Complications of baclofen pump placement include infection, malfunctioning and refraction to baclofen. [2] They can occur at the time of implantation and throughout the life of the implanted system. Any complication requiring removal or change of implant can be very expensive.…”

Section: Introductionmentioning

confidence: 99%

Pseudomeningocoele after baclofen pump placement in a child: a case report and preventive measures

Gupta¹,

Singh²,

Gunjan³

et al. 2017

Romanian Neurosurgery

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Abstract:Intrathecal baclofen therapy is a well-established means of treating intractable spasticity and dystonia in paediatric as well as adult population. Complications of baclofen pump placement include infection, malfunctioning and refraction to baclofen. We report a case of eight year child suffering from spasticity due to cerebral palsy, who developed pseudomeningocoele due to peri-catheter leak. Steps and precaution pertaining to pump implantation in a child are discussed. Baclofen pump insertion in a child needs some extra precautions due to non-availability of pediatric implants and poor built of the pediatric patient to adjust with a bulky device. Preventive measures should be taken to prevent peri-catheter CSF leak.

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“…Patients are usually required to undergo either general anesthesia or local anesthesia for pump implantation [4,5].…”

Section: Introductionmentioning

confidence: 99%

The effect of intrathecal baclofen single injection on neuropathic pain

Lee

Kim

et al. 2016

Anesth Pain Med

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:Baclofen is a gamma-aminobutyric acid B-receptor agonist, which is usually used for patients with spasticity or patients with nerve injury inducing both spasticity and neuropathic pain. Both oral administration and intrathecal injection via a continuous infusion pump are common treatment methods. The aim of this study was to evaluate the effectiveness of a series of three individual injections of intrathecal baclofen for neuropathic pain without spasticity. Methods: Thirty-one patients with neuropathic pain were treated with a series of three monthly individual injections of intrathecal baclofen without pump implantation A dose of 50 g of baclofen was used. 10-cm visual analog scale (VAS) scores of spontaneous pain, allodynia, and hyperalgesia were recorded a week after each injection. Vital signs were monitored to detect any hemodynamic changes, and a myelogram was performed to detect any undesirable cerebrospinal fluid leakage. All patients were hospitalized for at least one day following each injection for close observation and to control any adverse effects. Results: VAS scores of spontaneous pain, allodynia, and hyperalgesia decreased significantly (P ＜ 0.001). The major complications were general weakness, sleepiness, and urinary retention; most of these resolved within one day without any further serious symptoms. Conclusions: A series of three individual intrathecal baclofen injections was effective for those patients who suffered from neuropathic pain without spasticity or dystonia; no serious complications were observed. However, the average satisfaction score recorded for spontaneous pain was lower than those for allodynia and hyperalgesia. (Anesth Pain Med 2016; 11: 399-403)

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Complications of Intrathecal Baclofen Pump: Prevention and Cure

Cited by 69 publications

References 14 publications

Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience

Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience

Pseudomeningocoele after baclofen pump placement in a child: a case report and preventive measures

The effect of intrathecal baclofen single injection on neuropathic pain

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