Intrathecal baclofen (ITB) therapy, given via an implanted pump in the abdominal wall, is used to treat spasticity and dystonia associated with various brain and spinal cord conditions. Complications of ITB pumps are frequent, and significant morbidity can arise from their use, especially in children. (Pediatr Emerg Care 2017;33:271.)
Complications associated with ITB pumps are mechanical—secondary to pump or catheter problems—or infectious. Typically, pump or catheter problems occur gradually, and symptoms may be subtle. These include a slow or complete lack of tone improvement despite increasing dosages. Sudden interruption in ITB therapy from an acute pump or catheter malfunction can precipitate withdrawal and occur immediately or up to three days after cessation. (Pediatr Emerg Care 2017;33:271; Pain Physician 2015;18:E633.) Intrathecal baclofen withdrawal can be severe and even life-threatening, so it is critical to identify this condition early. (Pediatr Emerg Care 2017;33:271.). Symptoms of baclofen withdrawal include a sudden increase in spasticity, pruritus, hyperthermia, labile BP, seizures, vomiting, insomnia, DIC, and multisystem organ failure. (Pediatr Emerg Care 2017;33:271; Pain Physician 2015;18:E633.)
A good first test for patients with a suspected pump or catheter malfunction is AP and lateral abdominal radiographs to evaluate the integrity of the pump and catheter. (Pediatr Emerg Care 2017;33:271; J Pediatr Orthop 2010;30:76.) If unrevealing and there is no concern for infection, a contrast study may be necessary. Infectious complications typically occur within the first month or two after surgery, and patients can have superficial or deep infections or organ-space infections complicated by meningitis or bacteremia. (Pediatr Emerg Care 2017;33:271.)
This Clinical Pearl first appeared on EMedHome.com. Subscribers get a new clinical pearl emailed to them every Wednesday. Visitwww.EMedHome.com.
EMedHome.com on EM-News.com
Visit our website for videos and podcasts from Amal Mattu, MD, and other noted emergency physicians from EMedHome.com and EMedHome's video lectures at http://bit.ly/EMN-EMedHomeVideos.
This Month's Podcast
Amal Mattu, MD, and Colleagues: Lower GI Bleeds, Intubating Obese Patients, and the Cardiovascular Effects of Cocaine: http://bit.ly/MattuEMN. Dr. Mattu is one of the premier speakers in emergency medicine, and a professor of emergency medicine and the vice chair of emergency medicine at the University of Maryland School of Medicine in Baltimore.
This Month's Video
Haney Mallemat, MD: 2017 Resusfest: http://bit.ly/EMN-EMedHomeVideos. Dr. Mallemat is an associate professor of emergency medicine and internal medicine at the Cooper Medical School of Rowan University in Camden, NJ.