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The use of opioids in children receiving intrathecal baclofen therapy

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Abstract

Purpose

We hypothesized that children on chronic intrathecal baclofen therapy (ITB) may require less analgesics for postoperative pain control and are at higher risk of developing opioid-induced respiratory depression postoperatively. The aims of this study are to review children on chronic intrathecal baclofen therapy receiving opioids after major surgery and to determine the incidence complications in this population.

Method

We conducted a retrospective cohort study comparing 13 children on ITB, who underwent posterior spinal fusion surgery, to 17 children with spina bifida that received the same surgery.

Results

On postoperative day 0 (POD 0), four children (40%) had respiratory depression in the baclofen group compared to none in the control group. Desaturation was significantly more frequent in children in the ITB group compared to those of the control group on POD 0; oversedation was recorded in 8 (80%) children in the baclofen group vs. 3 (17.6%) in the control group. Desaturation, respiratory depression, and oversedation were significantly more frequent on POD 0 in children in the baclofen group compared with children in the control group.

Conclusions

The findings of the current study suggest that children on chronic intrathecal baclofen therapy require lesser amounts of opioids for postoperative pain control and are at a greater risk of developing postoperative respiratory depression and excessive sedation compared to patients without baclofen therapy.

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Authors and Affiliations

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

    Giuliana Rizzo, Leonardo Bussolin & Anna Zicca

  2. Department of Neurosurgery, Children’s Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139, Florence, Italy

    Lorenzo Genitori, Matteo Lenge & Flavio Giordano

  3. Pain and Palliative Care Unit, Children’s Hospital A, Meyer-University of Florence, 50139, Florence, Italy

    Andrea Messeri

Authors
  1. Giuliana Rizzo
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  2. Leonardo Bussolin
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  3. Lorenzo Genitori
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  4. Anna Zicca
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  5. Andrea Messeri
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  6. Matteo Lenge
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  7. Flavio Giordano
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Correspondence to Flavio Giordano.

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Rizzo, G., Bussolin, L., Genitori, L. et al. The use of opioids in children receiving intrathecal baclofen therapy. Childs Nerv Syst 35, 1213–1218 (2019). https://doi.org/10.1007/s00381-019-04155-7

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  • DOI: https://doi.org/10.1007/s00381-019-04155-7

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