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)

      Affiliations

    • 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 InformationCorresponding 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)

      Affiliations

    • Department of Anesthesiology and Critical Care, University of New Mexico - School of Medicine, Albuquerque, NM, USA
    • ,
  • Eli Torgeson, MD (Assistant Professor)

      Affiliations

    • Department of Anesthesiology and Critical Care, University of New Mexico - School of Medicine, Albuquerque, NM, USA
    • ,
  • Stephen Abram, MD (Professor)

      Affiliations

    • 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 ,Revised 29 November 2008 ,Accepted 1 December 2008.

References 

  1. Capdevila X, Barthelet Y, Biboulet P. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999;91:8–15
  2. Hodgson PS, Liu SS. New developments in spinal anesthesia. Anesthesiol Clin North America. 2000;18:235–249
  3. Zuniga RE, Schlicht CR, Abram SE. Intrathecal baclofen is analgesic in patients with chronic pain. Anesthesiology. 2000;92:876–880
  4. Slonimski M, Abram SE, Zuniga RE. Intrathecal baclofen in pain management. Reg Anesth Pain Med. 2004;29:269–276
  5. Sawynok J, Dickson C. Evidence for the involvement of descending noradrenergic pathways in the antinociceptive effect of baclofen. Brain Res. 1985;335:89–97
  6. Zielgansberger W. Dorsal horn neuropharmacology: baclofen and morphine. Ann NY Acad Sci. 1988;531:150–156
  7. Wilson P, Yaksh TL. Baclofen is antinociceptive in the spinal intrathecal space of animals. Eur J Pharmacol. 1978;51:323–420
  8. Hara K, Saito Y, Kirihara Y, Yamada Y, Sakura S, Kosaka Y. Interaction of antinociceptive effects of morphine and GABA receptor agonists within the rat spinal cord. Anesth Analg. 1999;89:422–427
  9. Hwang JH, Yaksh TL. The effect of spinal GABA receptor agonists on tactile allodynia in a surgically-induced neuropathic pain model in the rat. Pain. 1997;70:15–22
  10. Loubser PG, Akman NM. Effects of intrathecal baclofen on chronic spinal cord injury pain. J Pain Symptom Manage. 1996;12:241–247
  11. Herman RM, D'Luzansky JC, Ippolito R. Intrathecal baclofen suppresses central pain in patients with spinal lesions. Clin J Pain. 1992;8:338–345
  12. Middleton JW, Siddell PJ, Walker S, Molloy AR, Rutkowski SB. Intrathecal clonidine and baclofen in the management of spasticity and neuropathic pain following spinal cord injury: a case study. Arch Phys Med Rehabil. 1996;77:824–826
  13. Penn RD, Kroin JS. Long-term intrathecal baclofen infusion in the treatment of spasticity. J Neurosurg. 1987;66:181–185
  14. Ben Smail D, Jacq C, Denys P, Bussel B. Intrathecal baclofen in the treatment of painful, disabling spasms in Friedreich's ataxia. Mov Disord. 2005;20:758–759
  15. Vatine JJ, Magora F, Shochina M, Swissa A, Magora A. Effect of intrathecal baclofen in low back pain with root compression symptoms. Pain Clin. 1989;2:207–217
  16. Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970;49:924
  17. Miyoshi HR, Leckband SG. Systemic opioid analgesics. In:  Loesser JD editors. Bonica's Management of Pain. Philadelphia: Lippincott Williams & Wilkins; 2001;p. 1682–1710
  18. SAS Institute Inc . SAS/STATR 9.1 User's Guide. Cary (NC): SAS Institute Inc; 2004;
  19. R Development Core Team . R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2006;http://www.R-project.org
  20. de Oliveira Filho GR. The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method. Anesth Analg. 2002;95:411–416
  21. White RH, Romano PS, Zhou H, Rodrigo J, Bargar W. Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch Intern Med. 1998;158:1525–1531
  22. Mantilla CB, Horlocker TT, Schroeder DR, Berry DJ, Brown DL. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology. 2002;96:1140–1146
  23. Brander VA, Stulberg SD, Adams AD, et al. Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res. 2003;416:27–36
  24. Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998;87:88–92
  25. Gianino JM, York MM, Paice JA. Pharmacology of Baclothen and Morphine. In: Intrathecal Drug Therapy for Spasticity and Pain. New York: Springer-Verlag; 1996;p. 55–65
  26. Teoh H, Malcangio M, Bowery NG. GABA glutamate and substance P like immunoreactivity release: effects of novel GABA B antagonists. Br J Pharmacol. 1996;118:1153–1160
  27. Bormann J. Electrophysiology of GABA(A) and GABA(B) receptor subtypes. Trends Neurosci. 1998;11:112–116
  28. Melcangio M, Bowry NG. GABA and its receptors in the spinal cord. Trends Pharmacol Sci. 1996;17:457–462
  29. Dirig DM, Yaksh TL. Intrathecal baclofen and muscimol but not midazolam are antinociceptive in the rat formalin model. J Pharmacol Exp Ther. 1995;275:219–227
  30. Malan TP, Mata HP, Porreca F. Spinal GABA(A) and GABA(B) receptor pharmacology in a rat model of neuropathic pain. Anesthesiology. 2002;96:1161–1167
  31. Hartley RC, Barton-Hanson NG, Finley R, Parkinson RW. Early patient outcomes after primary and revision total knee arthroplasty. A prospective study. J Bone Joint Surg Br. 2002;84:994–999
  32. Salomone MM, Durieux ME. Revision total knee arthroplasty does not increase PACU utilization. Clin Orthop Relat Res. 2006;446:208–213
  33. Miner AL, Lingard EA, Wright EA, Sledge CB, Katz JN Kinemax Outcomes Group. Knee range of motion after total knee arthroplasty: how important is this as an outcome measure?. J Arthroplasty. 2003;18:286–294
  34. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC. J Rheumatol. 1988;15:1833–1840
  35. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop. 1989;248:13–14
  36. Forsythe ME, Dunbar MJ, Hennigar AW, Sullivan MJ, Gross M. Prospective relation between catastrophizing and residual pain following knee arthroplasty: two-year follow-up. Pain Res Manag. 2008;13:335–341
  37. Oertel B, Lötsch J. Genetic mutations that prevent pain: implications for future pain medication. Pharmacogenomics. 2008;9:179–194
  38. Chou WY, Yang LC, Lu JY. Association of μ-opioid receptor gene polymorphism (A118G) with variations in morphine consumption for analgesia after total knee arthroplasty. Acta Anaesthesiol Scand. 2006;50:787–792
  39. Harden RN, Bruehl S, Stanos S, et al. Prospective examination of pain-related and psychological predictors of CRPS-like phenomena following total knee arthroplasty: a preliminary study. Pain. 2003;106:393–400
  40. Roth ML, Tripp DA, Harrison MH, Sullivan M, Carson P. Demographic and psychosocial predictors of acute perioperative pain for total knee arthroplasty. Pain Res Manag. 2007;12:185–264
  41. Illgen RL, Pellino TA, Gordon DB, Butts S, Heiner JP. Prospective analysis of a novel long-acting oral opioid analgesic regimen for pain control after total hip and knee arthroplasty. J Arthroplasty. 2006;21:814–820
  42. Forst J, Wolff S, Thamm P, Forst R. Pain therapy following joint replacement. A randomized study of patient-controlled analgesia versus conventional pain therapy. Arch Orthop Trauma Surg. 1999;119:267–270

☆ Financial Support: GCRC Grant No.5MO1 RR00997.

PII: S0952-8180(09)00256-6

doi: 10.1016/j.jclinane.2008.12.019

Journal of Clinical Anesthesia
Volume 21, Issue 7 , Pages 486-492 , November 2009

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