Boster Aaron L, Adair Roy L, Gooch Judith L, Nelson Mary Elizabeth S, Toomer Andrea, Urquidez Joe, Saulino Michael
Adult Neurology, OhioHealth Neurological Physicians, Columbus, OH, USA.
Adult Physical Medicine & Rehabilitation, Advocate Christ Medical Center, Oak Lawn, IL, USA.
Neuromodulation. 2016 Aug;19(6):623-31. doi: 10.1111/ner.12388. Epub 2016 Jul 19.
Intrathecal baclofen (ITB) therapy aims to reduce spasticity and provide functional control.
An expert panel consulted on best practices.
Pump fill and drug delivery can be started intraoperatively, with monitoring for at least eight hours. Initiate with the 500 mcg/mL concentration. The starting daily dose should be twice the effective bolus screening dose, or the screening dose if the patient had a prolonged response (greater than eight hours) or negative reactions. Oral antispasmodics can be weaned, one drug at a time beginning with oral baclofen after ITB begins. Assessment should occur within 24 hours of a dose change. For adults, daily dose increases may be 5% to 15% once every 24 hours for cerebral-origin spasticity and 10% to 30% once every 24 hours for spinal-origin spasticity. Daily dose increases can be 5% to 15% once every 24 hours for children. Inpatients should be assessed at least every 24 hours and receive rehabilitation. Step dosing can be used for outpatients who cannot return daily. Dosing options include simple continuous dosing, variable 24-hour flex dosing, or regularly scheduled boluses. Patients/caregivers should understand the care plan, responsibilities, and possible side-effects. Low-reservoir alarm dates and refill schedules should be written down, along with emergency contact information. A higher concentration at refill can extend refill intervals, and a bridge bolus must be programmed. Time changes may affect flex dosing. Pump replacement should be scheduled at least three months in advance.
ITB dosing is multistep and individualized.
鞘内注射巴氯芬（ITB）疗法旨在减轻痉挛并实现功能控制。
一个专家小组就最佳实践进行了咨询。
泵填充和药物输送可在术中开始，监测至少八小时。从500 mcg/mL浓度开始。起始日剂量应为有效推注筛查剂量的两倍，或者如果患者有延长反应（超过八小时）或不良反应，则为筛查剂量。口服抗痉挛药可以逐渐减量，在ITB开始后从口服巴氯芬开始，一次一种药物。应在剂量改变后24小时内进行评估。对于成年人，对于脑源性痉挛，每日剂量增加可为每24小时5%至15%，对于脊髓源性痉挛，每24小时10%至30%。儿童每日剂量增加可为每24小时5%至15%。住院患者应至少每24小时评估一次并接受康复治疗。对于不能每日复诊的门诊患者可采用逐步给药。给药选项包括简单连续给药、可变24小时灵活给药或定期推注。患者/护理人员应了解护理计划、责任和可能的副作用。低储液器警报日期和补充时间表应记录下来，连同紧急联系信息。补充时使用较高浓度可延长补充间隔，并且必须设置桥接推注。时间变化可能会影响灵活给药。泵更换应至少提前三个月安排。
ITB给药是多步骤且个体化的。
