Prevention of intrathecal baclofen withdrawal syndrome: successful use of a temporary intrathecal catheter

Reg Anesth Pain Med. 2009 Nov-Dec;34(6):600-2. doi: 10.1097/AAP.0b013e3181b4cc6b.

Abstract

Abrupt cessation of intrathecal baclofen (ITB) administration can cause a life-threatening withdrawal syndrome that requires prompt diagnosis and urgent treatment. The current therapy for this condition is administration of propofol, benzodiazepines, paralytics and supportive care. This study reports a 53-year-old patient with paraplegia with an ITB infusion who presented with an infected pump site. The pump and the catheter were surgically removed and replaced with a temporary externalized intrathecal catheter. The ITB infusion was tapered and simultaneously substituted with progressively higher doses of oral antispasmotics. With this strategy, we were able to avoid life-threatening complications.

Publication types

  • Case Reports

MeSH terms

  • Accidents, Traffic
  • Administration, Oral
  • Anti-Bacterial Agents / therapeutic use
  • Baclofen / administration & dosage*
  • Baclofen / adverse effects
  • Catheter-Related Infections / microbiology*
  • Catheters, Indwelling / adverse effects*
  • Clonidine / administration & dosage
  • Clonidine / analogs & derivatives
  • Device Removal
  • Drug Administration Schedule
  • Humans
  • Infusion Pumps, Implantable
  • Infusions, Parenteral
  • Male
  • Middle Aged
  • Muscle Relaxants, Central / administration & dosage*
  • Muscle Relaxants, Central / adverse effects
  • Paraplegia / drug therapy*
  • Paraplegia / etiology
  • Spinal Cord Injuries / complications
  • Spinal Cord Injuries / drug therapy*
  • Substance Withdrawal Syndrome / etiology
  • Substance Withdrawal Syndrome / prevention & control*
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Muscle Relaxants, Central
  • tizanidine
  • Baclofen
  • Clonidine