Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 571-575 |
| Number of pages | 5 |
| Journal | Journal of Pediatric Orthopaedics |
| Volume | 35 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jan 1 2015 |
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Keywords
- Baclofen
- Cerebral palsy
- Orthopedic surgery
- Pain
- Spasticity
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Orthopedics and Sports Medicine
Cite this
Epidural baclofen for the management of postoperative pain in children with cerebral palsy. / Nemeth, Blaise A.; Montero, Robert J.; Halanski, Matthew A.; Noonan, Kenneth J.
In: Journal of Pediatric Orthopaedics, Vol. 35, No. 6, 01.01.2015, p. 571-575.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Epidural baclofen for the management of postoperative pain in children with cerebral palsy
AU - Nemeth, Blaise A.
AU - Montero, Robert J.
AU - Halanski, Matthew A.
AU - Noonan, Kenneth J.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - 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.
AB - 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.
KW - Baclofen
KW - Cerebral palsy
KW - Orthopedic surgery
KW - Pain
KW - Spasticity
UR - http://www.scopus.com/inward/record.url?scp=84942614640&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84942614640&partnerID=8YFLogxK
U2 - 10.1097/BPO.0000000000000329
DO - 10.1097/BPO.0000000000000329
M3 - Article
C2 - 26251959
AN - SCOPUS:84942614640
VL - 35
SP - 571
EP - 575
JO - Journal of Pediatric Orthopaedics
JF - Journal of Pediatric Orthopaedics
SN - 0271-6798
IS - 6
ER -