In this section
Baclofen is a GABA ß-agonist with muscle relaxing properties and is administered to reduce spasticity or dystonia.
Patient groups receiving ITB may include children and adolescents with:
Long term continuous ITB therapy is administered via a surgically implanted programmable pump. Surgical and hardware complications are managed by the Neurosurgical team.
The ITB pump programming and ongoing patient care is managed by the patient’s primary ITB team which is either:
The aim of the guideline is to outline the acute emergency and inpatient care for patients requiring Intrathecal Baclofen (ITB) therapy for all clinicians at RCH.
The following steps are recommended in the initial assessment of the child with an ITB pump:
A child with an ITB pump in situ may present to the emergency department for several reasons not related to ITB therapy. Consider differential diagnoses such as pain, anxiety, infection/sepsis/meningitis, epilepsy, malignant hyperthermia, intracranial haemorrhage, neuroleptic-malignant or serotonin syndrome
If concerned about baclofen overdose or withdrawal contact the on-call consultant of the child’s ITB treating team (Neurodevelopment & Disability or Rehabilitation Department).
A pump or catheter malfunction resulting in the over-delivery of IT baclofen
Patient sensitivity to dose of ITB
Mild – Moderate Symptoms:
Hypoglycaemia, electrolyte imbalance, epilepsy, infection/sepsis/meningitis, intracranial haemorrhage
Initiate MET as indicated
Notify the patient’s primary ITB team via switch
Review pump function. Cease or decrease ITB as indicated
A pump or catheter malfunction resulting in the under-delivery or cessation of IT baclofen delivery
A break or leak in the catheter
Disconnection of the catheter from the pump.
Movement of the catheter at a spinal level
Mild - Moderate Symptoms:
Most common cause of life-threatening event.
Initiate MET as indicated. A confirmed withdrawal should be managed in PICU.
If withdrawal is suspected but vital signs are within acceptable limits, notify primary ITB team urgently with aim to restore intrathecal dose of baclofen as quickly as possible.
Depending on severity of symptoms consider sequential dosing with:
If not effective consider Intravenous diazepam: 1-2mg/hr continuously, or IV infusion of clonidine up to 1-5 mcg/kg/hour.
Colonisation of bacteria in hardware of pump/catheter
Temperature > 38 °C
Redness or inflammation of wound or around pump
Swelling around pump
Inform neurosurgical team for review.
Inform primary ITB team.
Commence septic work up:
Consult with neurosurgery before considering Lumbar Puncture
Leak around insertion site of catheter into the intrathecal space
Catheter migration out of IT space
Urgently notify Neurosurgical team and ITB treating team
Investigations may include:
Imaging of the pump and catheter
Nuclear medicine/Dye flow study under video fluoroscopy- should be performed by a neurosurgeon
Surgical exploration of pump and catheter
Patients receiving ITB therapy may have an increased sensitivity to opiates.
Opiates should be given with caution, and in smaller doses in children with ITB pumps as respiratory depression may be more than anticipated.
Cease or reduce dose of opioids
Consider using other medications
Notify the patient’s treating team
Considerations for MRI, Lumbar Puncture, Epidural and Surgical cauterisation
Intrathecal Baclofen Evidence Table - coming soon.
Please remember to
read the disclaimer.
The revision of this nursing guideline was coordinated by Ingrid Sutherland, Clinical Nurse Consultant, Neurodevelopment and Disability, and Lillian Stagoll, CNC, Neurology, and approved by the Nursing Clinical Effectiveness Committee. Updated February 2023.