title: Epidural analgesia in a patient with an intrathecal catheter and subcutaneous pump to deliver baclofen.
abstract: Baclofen is used for the treatment of spasticity. Small doses administered intrathecally achieve high cerebrospinal fluid concentrations with reduced side-effects. Pediatric anesthesiologists are often reluctant to consider epidural analgesia in children receiving baclofen via an intrathecal catheter and subcutaneous pump. This reluctance is based on concerns for damaging the intrathecal catheter and introducing infection. In addition, the acute cessation of intrathecal baclofen can precipitate a life-threatening withdrawal state. We report a case of successful epidural analgesia in a patient receiving intrathecal baclofen and discuss the steps we took to minimize the chance of harm with this technique. We conclude that an intrathecal catheter and subcutaneous pump to deliver baclofen should not preclude the use of an epidural catheter for perioperative analgesia.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Children's Hospital and Regional Medical Center, Seattle, WA 98105, USA.
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Piper
authors.forename: Sean H
authors.initials: SH
authors.lastname: Flack
authors.forename: John D
authors.initials: JD
authors.lastname: Loeser
authors.forename: Anne M
authors.initials: AM
authors.lastname: Lynn
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural; D001418:Baclofen / Q000494:pharmacology*; D002404:Catheterization; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal
chemical_list: D001418:Baclofen