title: Prevention of intrathecal baclofen withdrawal syndrome: successful use of a temporary intrathecal catheter.
abstract: Abrupt cessation of intrathecal baclofen (ITB) administration can cause a life-threatening withdrawal syndrome that requires prompt diagnosis and urgent treatment. The current therapy for this condition is administration of propofol, benzodiazepines, paralytics and supportive care. This study reports a 53-year-old patient with paraplegia with an ITB infusion who presented with an infected pump site. The pump and the catheter were surgically removed and replaced with a temporary externalized intrathecal catheter. The ITB infusion was tapered and simultaneously substituted with progressively higher doses of oral antispasmotics. With this strategy, we were able to avoid life-threatening complications.
authors.affiliation: Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 62242, USA. Anke-Bellinger@uiowa.edu
authors.forename: Anke
authors.initials: A
authors.lastname: Bellinger
authors.forename: Rapipen
authors.initials: R
authors.lastname: Siriwetchadarak
authors.forename: Richard
authors.initials: R
authors.lastname: Rosenquist
authors.forename: Jeremy D W
authors.initials: JD
authors.lastname: Greenlee
mesh_terms: D000063:Accidents, Traffic; D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001418:Baclofen / Q000008:administration & dosage* / Q000009:adverse effects; D055499:Catheter-Related Infections / Q000382:microbiology*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003000:Clonidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D020878:Device Removal; D004334:Drug Administration Schedule; D006801:Humans; D015918:Infusion Pumps, Implantable; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000009:adverse effects; D010264:Paraplegia / Q000188:drug therapy* / Q000209:etiology; D013119:Spinal Cord Injuries / Q000150:complications / Q000188:drug therapy*; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D009125:Muscle Relaxants, Central; C023754:tizanidine; D001418:Baclofen; D003000:Clonidine