Anesth Pain Med.  2018 Apr;13(2):201-206. 10.17085/apm.2018.13.2.201.

Intrathecal baclofen pump implantation for complex regional pain syndrome in a patient with a spinal cord stimulator: consideration about optimal location of intrathecal catheter tip: A case report

• Ko MJ
• Lee HS
• Jo H
• Kim SR
• Jeon S
• Lee SE

• KMID: 2437430
• DOI: http://doi.org/10.17085/apm.2018.13.2.201

Abstract

Intrathecal baclofen (ITB) pump implantation can be used to control dystonia and severe pain associated with complex regional pain syndrome (CRPS) with or without a spinal cord stimulator (SCS). A 45-year-old female patient had gotten an SCS to control the pain of CRPS. However, she suffered from chronic intractable pain in her left ankle and foot despite paresthesia in the entire painful area because the effectiveness of the SCS gradually diminished over time. In a trial of intrathecal drug administration, baclofen was superior to morphine for pain relief, had fewer side effects, and was superior in terms of patient satisfaction. To achieve the greatest degree of pain relief from the ITB pump, the tip of the intrathecal catheter was carefully placed in relation to the SCS. Over a one-year follow-up period, the patient experienced mild pain without any adverse effects.

Keyword

Baclofen; Complex regional pain syndrome; Intrathecal pump; Spinal cord stimulation

MeSH Terms

Ankle
Baclofen*
Catheters*
Dystonia
Female
Follow-Up Studies
Foot
Humans
Middle Aged
Morphine
Pain, Intractable
Paresthesia
Patient Satisfaction
Spinal Cord Stimulation
Spinal Cord*
Baclofen
Morphine

Figure

• 

  Fig. 1 (A) Computed tomography showed the intrathecal catheter tip is located at same level with spinal cord stimulator’s 3rd lead (sweet spot of spinal cord stimulator) in thoracic vertebra 11. (B, C) The tip of intrathecal catheter (white arrow) is placed in ipsilateral (left) dorsal subarachnoid space at same level with the sweet spot (3rd lead) of spinal cord stimulator (black arrow) in thoracic vertebra 11 level.

• 

  Fig. 2 Digital infrared thermal imaging before and after intrathecal baclofen (ITB) pump implantation. (A, before) There were significant temperature differences more than 2°C between both ankle and foot before ITB pump implantation. (B, after) Symmetric temperature pattern was observed between both ankle and foot after ITB pump implantation.

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