Open AccessIntrathecal Baclofen Injection to Avoid Withdrawal in a Multiple Sclerosis Patient Undergoing Lumbar Spine Surgery: A Case Report
Author(s) -
Mirsad Dupanović,
Robert P Devine,
Sean R Jackson,
Sharon Lynch
Publication year - 2018
Publication title -
aanda practice
Language(s) - English
Resource type - Journals
ISSN - 2575-3126
DOI - 10.1213/xaa.0000000000000668
Subject(s) - spasticity , medicine , baclofen , anesthesia , multiple sclerosis , surgery , perioperative , intrathecal , receptor , psychiatry , agonist
Spasticity of spinal or cerebral origin is frequently treated with baclofen. Treatment interruption initially results in rebound spasticity; life-threatening withdrawal symptoms may follow. Severe rebound spasticity of leg muscles occurred in a multiple sclerosis patient after a 10-hour long perioperative pause of oral baclofen intake. In a subsequent spine surgery, recurrence was prevented by substituting a cumulative 12-hour oral baclofen dose with an intraoperative intrathecal injection. Administration of intrathecal baclofen during prolonged surgery in patients dependent on oral baclofen may improve patient comfort and prevent early withdrawal symptoms. The most optimal conversion ratio from oral to intrathecal baclofen is still undetermined.