Highlights
- •Muscular spasticity due to neurological disorders is a heavy cause of severe pain and disability for many patients.
- •Intrathecal baclofen therapy (ITB) is used as an important long term treatment to reduce spasticity.
- •The ultrasound examination may identify the access port of ITB to avoid multiple needle punctures, infections, radiation exposition.
Abstract
Muscular spasticity due to neurological disorders is a heavy cause of severe pain
and disability for many patients, compromising the independence and quality life.
Baclofene is a good tool to guarantee patients independence and pain control. Anyway
in chronic therapy oral treatment become unsatisfactory. In all these cases, intrathecal
baclofen therapy (ITB), after sub fascial implantation of intrathecal pumps is used
as an important long term treatment to reduce spasticity.
After pump implantation the drug reservoir must be refilled periodically in order
to maintain the reduction of spasticity and avoid the symptoms and signs of withdrawal.
ITB refilling, which involves the insertion of a needle through the skin until the
access port of the pump, is often hard, mainly due to the layer of abdominal fat,
spasticity, suboptimal pump positioning, pump rotation or inversion, and scar formation
over the implantation site. To avoid the difficulties of ITB refilling radiography
or other invasive supportive examinations are sometimes needed.
We reported here our experience and we suggest a simple method to use the ultrasound
in refilling with particular attention to some cases with complications after implantation
with a difficult approach in refilling. We used the ultrasound examination to identify
the access port of her pump so as to avoid multiple needle punctures and infections
and radiation exposition. Ultrasound-guided technique may facilitate ITB refill in
technically challenging cases.
With ultrasound ITB was easily detectable and was quite simple to identify the exact
point of needle injection.
In the last years different new applications for ultrasounds are emerging. In our
opinion the use of Doppler ultrasounds in the study of muscles and nerves represent
an emerging tool for the physician’s neurological rehabilitation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pain control in patients with cancer.Oncology. 1999; 13: 9-14
- Treatment of cancer-related pain: when orally administered medications fail.Mayo Clin Proc. 1994; 69: 473-480
- Continuous low-dose intrathecal morphine administration in the treatment of chronic pain of malignant origin.Mayo Clin Proc. 1981; 56: 516-520
- Current perspectives on intrathecal drug delivery.J Pain Res. 2014; 7: 615-626
- The implantable infusion pump: a new concept in drug delivery.Med Prog Technol. 1979; 30: 146-149
- Neuraxial medication delivery: the development and maturity of a concept for treating chronic pain of spinal origin.Spine. 2002; 27: 2593-2605
- Long-term intrathecal baclofen: outcomes after more than 10 years of treatment.PM&R. 2014; 6 (e1Y13.e1)
- Sonographic localization of an implanted infusion pump injection port: another useful application of ultrasound in pain medicine.Anesthesiology. 2005; 102: 243
- Ultrasound-guided refilling of an intrathecal baclofen pumpVa case report.Childs Nerv Syst. 2013; 29 (347Y9)
Mithra B, Maneyapanda George C, Chang Chien, Ryan Mattie DO, Prin Amorapanth, Christopher Reger, Zachary L. McCormick: ultrasound guidance for technically challenging intrathecal baclofen pump refill three cases and procedure description. Am J Phys Med Rehabil. doi:10.1097/PHM.0000000000000495.
- Intrathecal baclofen therapy: indications, pharmacology, surgical implant, and efficacy.Acta Neurochir Suppl. 2007; 97: 155-162
- Ultrasound guidance for technically challenging intrathecal baclofen pump refill: three cases and procedure description.Am J Phys Med Rehabil. 2016;
- A benefit-risk assessment of baclofen in severe spinal spasticity.Drug Saf. 2004; 27: 799-818
- Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients.Spinal Cord. 2004; 42: 686-693
- A review of the complications of intrathecal baclofen in patients with cerebral palsy.NeuroRehabilitation. 2007; 22: 383-395
- Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity.J Neurosurg Pediatr. 2015 Sep; 16: 335-339
- Migration of pump for intrathecal drug delivery into the peritoneal cavity.Case Rep Surg Neurol. 2009 May; 71: 610-612
- Baclofen pump pocket infection: a case report of successful salvage with muscle flap.Int Wound J. 2006 Mar; 3: 23-28
Article info
Publication history
Published online: September 04, 2018
Accepted:
August 13,
2018
Received:
April 18,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
