Baclofen is a medication used to manage severe spasticity, which is the involuntary stiffness and tightness of muscles. This condition often results from neurological disorders such as multiple sclerosis, spinal cord injuries, and cerebral palsy. The drug functions in the central nervous system by mimicking the effect of gamma-aminobutyric acid (GABA), the body’s main inhibitory neurotransmitter. Before any surgical procedure, a patient’s medication regimen, particularly those acting on the nervous system, must be thoroughly reviewed with the surgical and anesthesia team. Deciding whether to continue or stop Baclofen is complex due to the specific risks associated with both abrupt cessation and continued use alongside anesthesia.
Dangers of Abruptly Stopping Baclofen
Stopping Baclofen suddenly, even for a brief period before surgery, can trigger a serious and potentially life-threatening condition known as Baclofen Withdrawal Syndrome (BWS). The abrupt removal of the drug unmasks a state of hyperactivity in the central nervous system. The most immediate and common symptom is a severe return of spasticity, often called rebound spasticity, which may be significantly worse than the original condition.
Withdrawal symptoms can escalate rapidly from mild discomfort to severe systemic issues within hours to days of cessation. Patients may experience altered mental status, including confusion, delirium, and hallucinations. Physical signs often include high fever (hyperthermia) and increased muscle rigidity. The most concerning complications are seizures, which can occur even in patients with no prior history of epilepsy, and in rare, untreated cases, BWS can lead to the loss of function of multiple vital organs and death.
Interaction with Anesthesia Agents
While abruptly stopping Baclofen poses one set of dangers, continuing it during the perioperative period introduces risks related to drug interaction with anesthetic agents. Baclofen is a central nervous system (CNS) depressant, meaning it slows down brain activity. When combined with other CNS depressants commonly used in surgery, such as opioids for pain management, sedatives, and general anesthetics, this depressive effect is magnified.
The primary concern is an increased risk of respiratory depression, where the rate and depth of breathing become dangerously shallow. This additive effect can prolong the duration of sedation, making it difficult for the patient to wake up promptly after the procedure is finished. For patients receiving Baclofen via an intrathecal pump, the interaction with general anesthetics may also elevate the risk of cardiovascular disturbances. The combined sedative effects require the anesthesia team to monitor the patient’s breathing and circulation with heightened vigilance throughout and immediately following the surgery.
Essential Pre-Surgical Medication Management
The decision to continue, taper, or temporarily discontinue Baclofen must be made collaboratively by the patient and their medical team. The first step is to inform the prescribing physician, the surgeon, and the anesthesiologist about Baclofen use as soon as the surgery is scheduled. Because of the risks of withdrawal, many perioperative guidelines recommend that oral Baclofen be continued right up to and including the morning of the operation.
If a change in dosage is deemed necessary, a supervised tapering schedule must be implemented well in advance of the surgery. This planned, gradual reduction prevents the sudden drop in Baclofen levels that causes withdrawal. Patients with intrathecal Baclofen pumps require immediate consultation with a specialist who manages the pump, as their regimen involves a direct spinal infusion that must be precisely managed to prevent both withdrawal and overdose. Adherence to the plan provided by the medical team is necessary to safely navigate the dangers of withdrawal and synergistic depression during the surgical period.