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Epidural Baclofen for the Management of Postoperative Pain in Children With Cerebral Palsy
Blaise A Nemeth1, Robert J Montero, Matthew A Halanski
1*Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI †Department of Pediatric Orthopedics; Children's Hospital of Atlanta; Atlanta, GA.
Insights
Continuous epidural baclofen infusion did not significantly reduce pain or spasticity in children with cerebral palsy after surgery. Further research is needed for better pain and spasm management in these patients.
Area of Science:
- Orthopaedic Surgery
- Pediatric Anesthesiology
- Neurology
Background:
- Children with cerebral palsy (CP) often experience post-operative pain and spasticity.
- Differentiating pain from spasticity complicates management in CP patients.
- Continuous epidural baclofen infusion is explored as a method to control spasticity.
Purpose of the Study:
- To evaluate the efficacy of continuous epidural baclofen infusion in managing post-operative pain and spasticity in children with cerebral palsy undergoing lower extremity surgery.
- To compare outcomes between patients receiving epidural analgesia with and without continuous baclofen infusion.
Main Methods:
- Retrospective chart review of 44 pediatric patients with CP undergoing single event, multilevel lower extremity surgery.
- Patients received epidural analgesia, with a subset receiving continuous epidural baclofen infusion.
- Primary outcomes included need for supplemental narcotics and benzodiazepines; secondary outcomes included hospitalization duration, pain scores, and complications.
Main Results:
- No significant differences in the need for supplemental narcotic analgesia, benzodiazepines, or hospitalization duration were observed between groups.
- Pain scores were not statistically different between the baclofen and control groups (P=0.391).
- Mean arterial pressure was lower in the baclofen group (P=0.004), with no noted baclofen-related side effects.
Conclusions:
- Continuous epidural baclofen infusion is unlikely to significantly alter the pain-spasm cycle in pediatric CP patients post-orthopaedic surgery.
- More effective and cost-effective strategies for assessing and managing post-operative pain and muscle spasm in CP patients should be investigated.
Introduction:
Children with cerebral palsy undergoing soft tissue and bony procedures often experience pain and spasticity postoperatively. Differentiation of pain from spasticity complicates management, so controlling spasticity with a continuous infusion of baclofen, an antispasmodic, through an already present indwelling epidural catheter holds interest.
Methods:
A retrospective chart review was performed of patients with cerebral palsy undergoing single event, multilevel lower extremity surgery at a single institution who received epidural analgesia with or without continuous baclofen infusion. Primary outcomes included need for supplemental narcotic analgesics and benzodiazepines postoperatively. Duration of hospitalization, pain scores, and complications were also evaluated.
Results:
Forty-four patients were identified, ranging in age from 3 to 17 years, 19 of whom received epidural baclofen. No differences were found in use of supplemental narcotic analgesia, benzodiazepines, or duration of hospitalization. Differences in pain scores were not statistically significant (0.82±0.95 for baclofen vs. 1.48±0.99 for controls) (P=0.391). Mean arterial pressure was lower in patients receiving baclofen (P=0.004). No potential side effects attributable to baclofen were noted.
Conclusions:
Continuous epidural baclofen infusion seems unlikely to alter the pain-spasm cycle experienced by patients with cerebral palsy following orthopaedic surgery to a clinically significant degree. More effective, and cost-effective, measures at assessing and controlling pain and muscle spasm should be explored to benefit cerebral palsy patients postoperatively.
Level Of Evidence:
Level III-therapeutic study.
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