Continuous caudal epidural analgesia in a patient with an implanted intrathecal baclofen pump

Introduction: The use of epidural analgesia in patients with implanted intrathecal delivery devices is somewhat controversial. Major concerns include the risk of damaging the intrathecal catheter, the risk of infection, and the potential for interaction between the epidurally-administered and the intrathecally-delivered medication. In children with cerebral palsy, intrathecal administration of baclofen permits significantly higher CSF concentrations of the drug than with oral administration, allowing for greater reduction in spastic tone and lower incidence of side effects (1). Epidural analgesia is an attractive option for postoperative analgesia in these patients, who frequently have co-existing medical issues making the use of intravenous opioids for pain less desirable (2). In addition, cognitive impairment, visual or hearing loss, and communication or behavioural disturbances can make pain measurement difficult. This report describes the successful use of continuous caudal epidural analgesia in a patient with an implanted intrathecal baclofen pump.