Name of the Procedure:

Injection, Baclofen, 50 mcg for Intrathecal Trial
Commonly known as: Intrathecal Baclofen Injection Trial
Medical term: J0476 Injection

Summary

This procedure involves injecting a small dose of Baclofen directly into the spinal fluid (intrathecal space) to test its effectiveness in managing severe spasticity. The trial helps determine if a longer-term treatment with an intrathecal Baclofen pump would be beneficial.

Purpose

The injection aims to alleviate severe muscle spasticity that does not respond to oral medications. It is commonly used in conditions such as multiple sclerosis, spinal cord injuries, and cerebral palsy. The goal is to see if Baclofen administered directly into the spinal fluid can significantly reduce spasticity and improve mobility and comfort.

Indications

• Severe muscle spasticity unresponsive to oral medications.
• Conditions like multiple sclerosis, spinal cord injury, and cerebral palsy.
• Patients who experience significant side effects from oral Baclofen.
• Those considering long-term intrathecal Baclofen pump therapy.

Preparation

• Fasting may be required for a few hours before the procedure.
• Regular medications should be taken as prescribed unless specifically instructed otherwise by the healthcare provider.
• Pre-procedure diagnostic tests may include blood work and an MRI or CT scan of the spine.

Procedure Description

1. The patient lies on their side or sits up, with the back curved outward.
2. The skin is cleaned and a local anesthetic is applied to numb the area.
3. A thin needle is inserted into the intrathecal space of the lower spine.
4. 50 mcg of Baclofen is injected through the needle.
5. The needle is removed and a bandage is applied to the injection site.

Duration

The injection itself takes around 15 to 30 minutes. However, the patient may need to stay for several hours for observation.

Setting

The procedure is typically performed in a hospital or an outpatient clinic.

Personnel

• A neurologist or anesthesiologist performs the injection.
• Nurses assist with preparation and post-procedure care.
• A radiologist may be involved for image guidance during the procedure.

Risks and Complications

Common risks include:

• Headache
• Nausea
• Dizziness Rare but possible complications:
• Infection
• Bleeding at the injection site
• Adverse reaction to the medication
• Spinal fluid leakage

Benefits

• Potential for significant reduction in severe spasticity.
• Better mobility and improved quality of life.
• Determination if the patient is a good candidate for long-term intrathecal Baclofen therapy.

Recovery

• Rest for the remainder of the day after the procedure.
• Avoid strenuous activities for 24-48 hours.
• Follow-up appointments to assess the efficacy of the injection and to discuss long-term treatment options.

Alternatives

• Oral Baclofen, though it may cause more side effects or be less effective.
• Other oral antispasmodic medications.
• Physical therapy and other non-medical approaches.
• Surgical options for severe cases, such as tendon release surgeries.

Patient Experience

During the procedure:

• Some discomfort or pressure during needle insertion.
• Local anesthetic reduces pain at the injection site. After the procedure:
• Temporary headache or nausea.
• Monitoring for several hours to ensure no adverse reactions.
• Pain medication provided if needed to manage post-procedure discomfort.