Managing spasticity in spinal cord injury: safe administration of bridge boluses during intrathecal baclofen pump refills.
Intrathecal baclofen now plays an important role in the management of spasticity in a number of neurologic conditions including spinal cord disorders. Dosage errors can be a source of significant morbidity and the risk is greatest when the clinician is changing solution concentration. When changing concentrations, it is imperative to program the pump correctly by incorporating a bridge bolus to compensate for the residual baclofen solution in the pump and catheter. This paper reviews the appropriate methods to safely calculate the bridge bolus, with an illustrative example.
Elovic
Elie
E
Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey, USA. eelovic@kmrrec.org
Kirshblum
Steven C
SC
D001418:Baclofen / Q000008:administration & dosage* / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D015918:Infusion Pumps, Implantable; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000188:drug therapy*
D009125:Muscle Relaxants, Central; D001418:Baclofen