[Intrathecal baclofen for children with chronic pain related to severe spasticity: advantages of tunneling the catheter in the testing phase]. / Baclofeno intratecal en niños con dolor crónico por espasticidad intensa: ventajas de la tunelización del cateter en la fase diagnóstica.

OBJECTIVE: To document the effectiveness and safety of intrathecal baclofen administered through a tunneled catheter during a diagnostic procedure, prior to implantation of a subcutaneous pump, in children with chronic pain due to severe spasticity. METHODS: This was a retrospective study of 6 children with intense chronic pain due to spasticity caused by cerebral palsy or genetic dystonia. Increasing doses of intrathecal baclofen in continuous perfusion through a tunneled catheter were tested. RESULTS: Lumbar intrathecal catheters were tunneled for 48 to 80 hours in 5 males and 1 female aged 8 to 18 years old. Intrathecal baclofen was administered in continuous perfusion up to maximum rates that ranged between 105 and 570 microg/day. For 5 patients the score on the visual analog pain scale (0-10) changed from over 7 to 0 by the end of the test. In 2 patients, side effects of analgesia were noted, specifically sedation, bradycardia, and bradypnea. No serious complications, such as meningitis, spinal abscess, or hematoma, were reported. The families of 4 patients chose to accept implantation of a subcutaneous pump. Pump therapy remained effective and free of complications when checked 23 or 55 months after placement. CONCLUSIONS: Performing a trial of increasing doses of intrathecal baclofen therapy in continuous perfusion through a tunneled catheter facilitated selection of patients for whom chronic administration of intrathecal baclofen is effective and free of complications.

Baclofeno intratecal en niños con dolor crónico por espasticidad intensa: ventajas de la tunelización del catéter en la fase diagnóstica / Intrathecal baclofen for children with chronic pain related to severe spasticity: advantages of tunneling the catheter in the testing phase

OBJETIVO: Documentar la efectividad y seguridad dela administración diagnóstica de baclofeno intratecal(BIT) a través de catéteres intratecales tunelizados(CITT) en niños con dolor crónico por espasticidadintensa, previamente a la implantación de una bombasubcutánea.MÉTODOS: Se realizó un estudio retrospectivo de 6niños con dolor crónico intenso por espasticidad secundariaa parálisis cerebral o distonía genética, en los quese procedió a realizar una prueba con dosis crecientes deBIT en perfusión continua a través de un CITT.RESULTADOS: En 5 niños y 1 niña (8 a 18 años) se tunelizóun CITT lumbar durante 48 a 80 horas. Se administróBIT en perfusión continua hasta llegar a una velocidadmáxima que osciló entre 105 y 570 μg/día. En 5casos la escala de dolor pasó de una puntuación superiora 7 (en una EVA parental de 0 a 10) al inicio del tratamientoa 0 al final de la prueba. En 2 casos la analgesiase asoció a efectos secundarios de sedación, bradicardiay bradipnea. En ningún caso se observaron complicacionesimportantes como meningitis, abscesos espinales ohematomas. En los cuatro casos en que la familia delpaciente decidió la implantación definitiva de una bombasubcutánea ésta siguió siendo efectiva entre los 55 ylos 23 meses tras su implantación y sin complicaciones.CONCLUSIONES: La realización de la prueba conBIT en perfusión continua a dosis crecientes medianteCITT permitió seleccionar los pacientes en los quela administración crónica de baclofeno intratecal esefectiva y no presenta complicaciones

OBJECTIVE: To document the effectiveness and safetyof intrathecal baclofen administered through a tunneledcatheter during a diagnostic procedure, prior to implantationof a subcutaneous pump, in children with chronicpain due to severe spasticity.METHODS: This was a retrospective study of 6 childrenwith intense chronic pain due to spasticity causedby cerebral palsy or genetic dystonia. Increasing doses ofintrathecal baclofen in continuous perfusion through atunneled catheter were tested.RESULTS: Lumbar intrathecal catheters were tunneledfor 48 to 80 hours in 5 males and 1 female aged 8 to 18years old. Intrathecal baclofen was administered in continuousperfusion up to maximum rates that ranged between105 and 570 μg/day. For 5 patients the score onthe visual analog pain scale (0-10) changed from over 7to 0 by the end of the test. In 2 patients, side effects ofanalgesia were noted, specifically sedation, bradycardia,and bradypnea. No serious complications, such asmeningitis, spinal abscess, or hematoma, were reported.The families of 4 patients chose to accept implantation ofa subcutaneous pump. Pump therapy remained effectiveand free of complications when checked 23 or 55 monthsafter placement.CONCLUSIONS: Performing a trial of increasingdoses of intrathecal baclofen therapy in continuousperfusion through a tunneled catheter facilitatedselection of patients for whom chronic administrationof intrathecal baclofen is effective and free of complications