COMPLICATIONS ASSOCIATED WITH INTRATHECAL CONTINUOUS INFUSION BACLOFEN PUMPS FOR SPASTICITY TREATMENT - 14 YEARS OF EXPERIENCE
Background and goal of study:
Intrathecal implantation of continuous infusion baclofen pumps (CIBP) for spasticity treatment is not free from complications. 1,2,3 These may be related to surgery (infection, dehiscence of the suture), human errors (over or under-dose by programming errors), pump-related (battery failure, migration or rotation within the pocket) or catheter-related (disconnection,  kinking, fracture and catheter tip granuloma). Complications can lead in rare cases to death (for severe infection or baclofen withdrawal syndrome).2,3 Our study describes complications in patients with CIBP for spasticity treatment.
Material and Methods:
After study approval by the institutional ethics committee, a retrospective observational study was conducted in patients under treatment in our Chronic Pain Unit, with CIBP. Only patients with complete records were included. 75 patients were evaluated. Collected data were submitted to a descriptive analysis of the variables.
Result and Discussion:
Average years of follow-up was 7.2 (range 0.9 to 13.4 years). 104 CIBP (average 7.4 pumps / year) were placed. Mean time free from complications was 7.9 years. 56% (n = 42) patients  had no complications.  Battery failure (end of life) occurred in 66.7% (n = 22) patients, intrinsic pump failure in 12% (n = 9) and implant infection in 2.6% (n = 2). Pump replacement took place in 38.7% (n = 29) of patients. Of these, 75.9% (n = 22) had battery failure. Among patients with complications, only 15.2% (n = 5) had a second complication. No differences were found related to sex, age or spasticity cause.
Conclusion:
All registered complications were related to technical failure of the pump, except two patients who presented implant infection. There were no human errors. The most frequent complication was battery failure in 66.7% of cases, also responsible for the largest number of replacements of CIBP (75.9%). There are no records of deaths or events associated with side effects to baclofen.
References:
1N Engl J Med 1989;320:1517-21; 2Neurochirurgie 2003;49:276-88; 3J Intellect Dev Disabil 2011;36:207-13.

Complications associated with intrathecal continuous infusion baclofen pumps for spasticity treatment - 14 years of experience