Intrathecal baclofen for postoperative analgesia after total knee arthroplasty

Sanders, John C.; Gerstein, Neal; Torgeson, Eli; Abram, Stephen

doi:10.1016/j.jclinane.2008.12.019

« Previous Next »Journal of Clinical Anesthesia
Volume 21, Issue 7 , Pages 486-492, November 2009

Intrathecal baclofen for postoperative analgesia after total knee arthroplasty☆

John C. Sanders, MB BS, FRCA (Associate Professor)
- Department of Anesthesiology and Critical Care, University of New Mexico - School of Medicine, Albuquerque, NM, USA
- Shriners Hospitals for Children, Salt Lake City, UT 84103, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
- Corresponding author. Shriners Hospitals for Children, Salt Lake City, UT 84103, USA. Tel.: +1 801 536 3600; fax: +1 801 536 3630.
Neal Gerstein, MD (Assistant Professor)
- Department of Anesthesiology and Critical Care, University of New Mexico - School of Medicine, Albuquerque, NM, USA
Eli Torgeson, MD (Assistant Professor)
- Department of Anesthesiology and Critical Care, University of New Mexico - School of Medicine, Albuquerque, NM, USA
Stephen Abram, MD (Professor)
- Department of Anesthesiology and Critical Care, University of New Mexico - School of Medicine, Albuquerque, NM, USA
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA

Received 30 September 2007; received in revised form 29 November 2008; accepted 1 December 2008. published online 26 October 2009.

Abstract

Study Objective

To determine whether intrathecal baclofen is an effective adjunctive agent to decrease acute and chronic postoperative pain after total knee arthroplasty.

Design

Prospective, randomized, double-blind controlled trial.

Setting

Operating room and inpatient units of a university hospital.

Patients

60 adult, ASA physical status I, II, and III patients presenting for total knee arthroplasty.

Interventions

Anesthesia was provided by spinal injection of 15 mg of 0.75% hyperbaric bupivacaine combined with either 100 mcg baclofen or saline. Sedation was provided with intravenous midazolam and propofol.

Measurements

Data were collected on adverse effects, opioid usage, and verbal pain scale (VPS) from 0 to 10. The study period was divided into six discrete time intervals that included the 1^st 72-hour postoperative period and a three-month post-discharge follow-up telephone call.

Main Results

The baclofen group used less morphine in the PACU than the control group (5 mg vs. 9.3 mg; P = 0.04). VPS were lower in the baclofen group than the treatment group, but significant differences could be demonstrated only in the time periods 48-72 hours and three months postoperatively. At three months, fewer patients in the baclofen group reported pain than the control group (8/27 vs. 19/29; P = 0.009). Regression analysis showed that the baclofen group was 4.5 times less likely to report pain at three months (95% CI: 1.5–16.6).

Conclusions

IT baclofen used as an adjuvant to spinal anesthesia for total knee arthroplasty allows for less postoperative opioid usage and less chronic pain at three months.

Keywords: Anesthesia, Spinal, Baclofen, Intrathecal, Knee arthroplasty