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The use of opioids in children receiving intrathecal baclofen therapy

Giuliana Rizzo1, Leonardo Bussolin1, Lorenzo Genitori2

  • 1Department of Pediatric Neuroanesthesia and Neuro Intensive Care Unit, Children's Hospital A. Meyer-University of Florence, 50139, Florence, Italy.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|April 28, 2019
PubMed

Insights

Children on intrathecal baclofen therapy (ITB) may need fewer opioids post-surgery but face higher risks of respiratory depression and oversedation. Close monitoring is crucial for this patient group.

Area of Science:

  • Pediatric Anesthesiology
  • Neuropharmacology
  • Spinal Surgery

Background:

  • Chronic intrathecal baclofen therapy (ITB) is used for spasticity management in children.
  • The impact of ITB on postoperative pain control and respiratory safety in pediatric surgical patients is not well-defined.

Purpose of the Study:

  • To investigate the incidence of complications in children on chronic ITB receiving opioids after major surgery.
  • To assess the need for analgesics and the risk of opioid-induced respiratory depression in this population.

Main Methods:

  • Retrospective cohort study comparing children on ITB undergoing posterior spinal fusion with a control group.
  • Analysis of postoperative complications including respiratory depression, desaturation, and oversedation.

Main Results:

  • Children on ITB experienced significantly higher rates of respiratory depression (40% vs. 0%), desaturation, and oversedation (80% vs. 17.6%) on postoperative day 0.
  • The ITB group required less opioid analgesia postoperatively.

Conclusions:

  • Children on chronic ITB may require less opioid analgesia but are at increased risk for postoperative respiratory depression and excessive sedation.
  • Enhanced vigilance and tailored pain management strategies are necessary for pediatric patients on ITB undergoing major surgery.
Abstract

Keywords:
BaclofenChildrenOppioidRespiratory depression

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