Is a one-time dose of baclofen (GABA receptor agonist) safe for treating muscle spasm in post-operative patients?

Safety of One-Time Baclofen Dose for Muscle Spasm in Post-Operative Patients

A one-time dose of baclofen is safe for treating muscle spasm in post-operative patients and should be administered when needed for symptom relief. 1

Evidence-Based Rationale

• The Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement explicitly recommends taking baclofen preoperatively including on the day of operation, indicating its safety in the perioperative setting 1
• Baclofen is a GABAB receptor agonist that acts as a centrally acting muscle relaxant, making it pharmacologically appropriate for treating post-operative muscle spasms 1
• Single-dose administration avoids the risks associated with long-term use or abrupt discontinuation of chronic baclofen therapy 1

Important Considerations for Administration

• Baclofen should be dosed appropriately based on:

  • Patient age (lower doses in elderly patients) 1
  • Renal function (dose adjustment may be needed in renal impairment) 1
  • Hepatic function (caution in hepatic impairment) 1

• Potential side effects to monitor with one-time dosing include:

  • Sedation and drowsiness 1
  • Dizziness 1
  • Potential for increased risk of falls, especially in elderly patients 1

Special Populations and Precautions

• Elderly patients: Use with caution as they may be more sensitive to central nervous system effects; consider lower dosing 2
• Patients with obstructive sleep apnea: Baclofen may potentially worsen OSA by provoking upper airway collapse during sleep, though evidence is limited for single-dose administration 1
• Post-operative pain management: Consider as part of multimodal analgesia approach, which may help reduce opioid requirements 1

Contraindications and Cautions

• Avoid in patients with:
  • Known hypersensitivity to baclofen 1
  • Severe renal impairment 1
  • Concurrent use of other CNS depressants requires dose adjustment to prevent excessive sedation 1

Important Distinction Between Single-Dose and Chronic Use

• The safety concerns with baclofen primarily relate to chronic use and abrupt discontinuation rather than single-dose administration 1
• Withdrawal symptoms (including hallucinations, anxiety, agitation, delirium) are a concern with long-term use but not with single-dose therapy 3
• Recent evidence suggests caution when using muscle relaxants like baclofen in older adults undergoing spinal fusion, as it may increase delirium risk when used as part of post-operative pain management 2

Conclusion

A single dose of baclofen is safe for managing post-operative muscle spasms when appropriately prescribed with consideration of patient factors. The benefits of effective muscle spasm relief generally outweigh the risks of a one-time dose, particularly when compared to the potential adverse effects of untreated severe muscle spasms or the need for higher doses of opioid analgesics 1.