Injection, Baclofen, 10 mg (J0475)

Name of the Procedure:

• Common Name: Baclofen Injection
• Technical/Medical Term: Intrathecal Baclofen Injection

Summary

Injection of Baclofen, a muscle relaxant, typically delivered via an intrathecal pump directly into the spinal fluid to relieve severe muscle spasticity.

Purpose

• Medical Conditions Addressed: Severe spasticity due to spinal cord injuries, multiple sclerosis, or other neurological conditions.
• Goals/Expected Outcomes: Reduction in muscle spasms and pain, improvement in mobility and quality of life.

Indications

• Symptoms/Conditions: Severe, chronic muscle spasms not controlled by oral medications.
• Patient Criteria: Patients who meet the criteria for intrathecal administration, typically those who have not responded adequately to oral medications or who experience intolerable side effects from them.

Preparation

• Pre-procedure Instructions: Fasting may be required. Patients may need to adjust or discontinue certain medications as advised by their healthcare provider.
• Diagnostic Tests/Assessments: Evaluation to confirm diagnosis and suitability for intrathecal treatment. Imaging studies (e.g., MRI, CT scan) and possibly a trial of intrathecal baclofen via lumbar puncture.

Procedure Description

1. Step-by-Step Explanation:
   • Patient positioned for sterile access to the lumbar spine.
   • Local anesthesia administered at the injection site.
   • Needle inserted into the spinal canal and baclofen injected.
   • For long-term treatment, a pump may be surgically implanted to deliver continuous infusions.
2. Tools/Equipment: Needles, syringes, local anesthetics, possibly an implantable pump.
3. Anesthesia/Sedation: Local anesthesia is typical; general anesthesia may be used if a pump is implanted.

Duration

• The injection itself typically takes 15-30 minutes.
• The implantation of the pump, if required, may take 1-2 hours.

Setting

• Injection: Outpatient clinic, hospital.
• Pump Implantation: Hospital or surgical center.

Personnel

• Healthcare Professionals Involved: Neurologists, pain specialists, anesthesiologists, surgeons, and nurses.

Risks and Complications

• Common Risks: Infection, bleeding at the injection site, headache.
• Rare Risks: Catheter malfunction, cerebrospinal fluid leakage, overdose leading to respiratory depression.
• Management of Complications: Immediate medical intervention, adjustment of medication dosage, and potentially surgical revision for implanted pumps.

Benefits

• Expected Benefits: Significant reduction in muscle spasticity, improved mobility, and pain relief.
• Timeline for Benefits: Benefits may be observed within days for injections; continuous pump infusions provide ongoing relief.

Recovery

• Post-Procedure Care: Monitoring for adverse reactions immediately after the procedure. For pump implantations, wound care and limited physical activity.
• Expected Recovery Time: Immediate recovery for injections; a few days to two weeks for pump implantation.
• Restrictions/Follow-Up: Follow up to adjust pump settings if used, and routine appointments to monitor effectiveness and any side effects.

Alternatives

• Other Treatment Options: Oral medications, physical therapy, Botox injections, surgery.
• Pros and Cons: Oral medications have systemic side effects; physical therapy may not fully control symptoms; Botox can be very effective but only for focal spasticity; surgery is irreversible and has its own set of risks.

Patient Experience

• During Procedure: Mild discomfort or pressure during injection; pain and discomfort managed via anesthesia for surgical implantation.
• After Procedure: Possible initial mild discomfort at the injection or surgical site; gradual improvement in symptoms. Pain management strategies include medications and rest.