[Intrathecal baclofen for children with chronic pain related to severe spasticity: advantages of tunneling the catheter in the testing phase].
OBJECTIVE
To document the effectiveness and safety of intrathecal baclofen administered through a tunneled catheter during a diagnostic procedure, prior to implantation of a subcutaneous pump, in children with chronic pain due to severe spasticity.


METHODS
This was a retrospective study of 6 children with intense chronic pain due to spasticity caused by cerebral palsy or genetic dystonia. Increasing doses of intrathecal baclofen in continuous perfusion through a tunneled catheter were tested.


RESULTS
Lumbar intrathecal catheters were tunneled for 48 to 80 hours in 5 males and 1 female aged 8 to 18 years old. Intrathecal baclofen was administered in continuous perfusion up to maximum rates that ranged between 105 and 570 microg/day. For 5 patients the score on the visual analog pain scale (0-10) changed from over 7 to 0 by the end of the test. In 2 patients, side effects of analgesia were noted, specifically sedation, bradycardia, and bradypnea. No serious complications, such as meningitis, spinal abscess, or hematoma, were reported. The families of 4 patients chose to accept implantation of a subcutaneous pump. Pump therapy remained effective and free of complications when checked 23 or 55 months after placement.


CONCLUSIONS
Performing a trial of increasing doses of intrathecal baclofen therapy in continuous perfusion through a tunneled catheter facilitated selection of patients for whom chronic administration of intrathecal baclofen is effective and free of complications.
Gómez-Hoz
T
T
Servicio de Anestesia-Reanimación y Unidad de Dolor Infantil, Hospital Universitario "La Paz", Madrid.
Reinoso-Barbero
F
F
de Vicente
J C
JC
Duran
P
P
Campo
G
G
Castro
L E
LE
D000293:Adolescent; D001418:Baclofen / Q000008:administration & dosage / Q000627:therapeutic use*; D002404:Catheterization / Q000379:methods*; D002408:Catheters, Indwelling; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002908:Chronic Disease; D020821:Dystonic Disorders / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable; D007263:Infusions, Parenteral / Q000295:instrumentation*; D008161:Lumbosacral Region; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011996:Records; D012189:Retrospective Studies; D012720:Severity of Illness Index
D009125:Muscle Relaxants, Central; D001418:Baclofen