From the Guidelines
Muscle spasticity after femoral bypass grafting is most likely caused by immobilization, reduced oral intake, anesthesia, tissue damage, and subsequent immune system activation and metabolic changes, as evidenced by the metabolic response to immobilization and surgical trauma 1. The causes of muscle spasticity after femoral bypass grafting can be multifactorial, including:
- Immobilization, which leads to a decline in basal energy expenditure, reduced insulin sensitivity, anabolic resistance to protein nutrition, muscle strength, and physical performance, as well as increased risk of falls, health-related expenditure, morbidity, and mortality 1
- Reduced oral intake, which can result in a catabolic state, leading to muscle breakdown and loss of lean muscle mass 1
- Anesthesia and tissue damage, which can cause inflammation and oxidative stress, contributing to muscle damage and spasticity 1
- Metabolic changes, including increased resting energy expenditure, mobilization of glucose and glutamine for wound healing, and amino acids for acute phase protein synthesis, which can lead to muscle loss and spasticity 1 It is essential to note that the loss of muscle mass and function can occur rapidly, with just seven days of bedrest resulting in 1 kg loss of lean leg muscle mass, and that older adults are more susceptible to these changes 1. In terms of management, a comprehensive approach should be taken, including:
- Early mobilization and physical therapy to prevent muscle atrophy and promote recovery 1
- Adequate nutrition, including protein intake exceeding 1 g/kg body weight/day, to support muscle protein synthesis and prevent muscle loss 1
- Pain management, using scheduled acetaminophen and short-term NSAIDs (if not contraindicated), to reduce muscle spasms and promote recovery 1 By addressing these factors and implementing a comprehensive management plan, it is possible to reduce the incidence and severity of muscle spasticity after femoral bypass grafting, ultimately improving patient outcomes and quality of life.
From the Research
Causes of Muscle Spasticity
There are no research papers provided that directly address the causes of muscle spasticity after femoral bypass grafting.
General Information on Spasticity
- Spasticity is a motor disorder characterized by tight or stiff muscles that may interfere with voluntary muscle movements 2.
- It is a problem for many patients with multiple sclerosis, spinal cord injury, cerebral palsy, and acquired brain injury 2.
- Spasticity may be associated with significant pain or discomfort, skin breakdown, contractures, sleep disorders, and difficulty in transfer 2.
Treatment of Spasticity
- Existing treatments for spasticity include physical therapy, oral medications, injections of phenol or botulinum toxin, or surgical intervention 2.
- Baclofen is a muscle relaxant and antispasticity drug that can be administered orally or intrathecally 2, 3, 4.
- Intrathecal baclofen infusion is a treatment option for patients with severe spasticity who are unresponsive or cannot tolerate oral baclofen 2, 3, 4.
Management of Spasticity
- Management of spasticity seeks to reduce its burden on patients and to limit secondary complications 5.
- Non-operative interventions, such as stretching/splinting, postural management, physical therapy/strengthening, anti-spasticity medications, and botulinum toxin injections, may help patients with spasticity 5, 6.
- Surgical management, including orthopaedic management, may be necessary to improve quality of life and prevent complications 5.