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Post Operative Recommendations

 


What are the post-operative recommendations?

After surgery the child will experience some discomfort and tenderness where the pump and catheter have been inserted. The wound sites should not require any special care, however the surgeons may prescribe a course of antibiotics to prevent any infections.
The team should be notified of any redness, swelling or soreness at the site of the wounds. Headaches may also be experienced during the first week after surgery. These can be relieved by using painkillers but if they persist despite taking pain relief, it is recommended to contact a member of the ITB team. Activities should be restricted for a few weeks after surgery until the implanted pump has time to settle. Please see Physiotherapy recommendations.


Physiotherapy recommendations.
The following recommendations are made to reduce the risk of infection, to keep the patient's skin around the pump site healthy, and to reduce the longer-term risk of damage or malfunction of the device or interference with safe drug delivery. Your child should not go swimming or have hydrotherapy until wounds are fully healed - typically six weeks. Equipment (e.g. lap straps, harnesses, slings) and orthotic devices (e.g. spinal jackets, lycra suits) should be checked to ensure there is not undue pressure against the device. Your child's postural management and mobility needs will require regular monitoring whilst the daily dose is being increased. They should become more relaxed and have less stiffness when undertaking cares, seating etc and so may require more support or assistance than previously.
For 3 months, your child will need to avoid activities that involve sudden, excessive, repeated trunk movements, particularly to the end range of passive movement.
Examples include:
1. The "cobra" yoga position
2. Therapy involving end range trunk mobilization
3. Repetitive sit ups with trunk rotation
4. Bouncing: the use of rebound is generally discouraged. Where used, careful risk assessment is recommended. See http://www.reboundtherapy.org/papers/rebound_therapy/csp_safe_practice.pdf
5. Horse riding
6. Some forms of "rough and tumble" play

Be mindful of shearing / direct pressure over side where the catheter or the pump is sited. Examples include: 1. Standing slings that exert pressure around the torso (pelvic supports are not a concern) 2. Manually assisted transfers where the child is lifted from under the arms.
We advise against contact sports or activities with significant risk of direct trauma to the pump or catheter. Wheelchair sports may continue provided consideration is given to the likelihood of body contact and the need for protective padding.

Other Recommendations
See http://www.baclofenpump.com/living/during-treatment/cautions-medical-procedures/index.htm for further information.
MRI scans: Special precautions are required as the MRI scan will temporarily stop the ITB pump.  Although the pump is designed to re-start itself, the device should be medically checked after the MRI to confirm it is working properly. Whenever your child is booked for an MRI scan, please tell the treating doctors/ nurses at the earliest opportunity that he/she has a baclofen pump.

Spinal surgery: Any planned spinal surgery requires careful collaboration between spinal and neurosurgical services given the significant risk of catheter damage during spinal surgery.  Where spinal fusion is anticipated, the intrathecal infusion pump should ideally be sited prior to spinal surgery. Hyperbaric oxygen therapy (HBOT): Medtronic (baclofenpump.com) advises that high pressure environments can affect drug delivery rate posing a risk of under-dosing.  HBOT aimed at neurodevelopmental outcomes should not be undertaken. HBOT for any other reason requires careful consideration and collaboration with the treating ITB centre before starting. Power plate / Vibrogym machines: These are not advised as the high frequency vibration poses risk to the drug delivery system. Hot tubs, steam rooms, saunas, tanning beds: Medtronic (baclofenpump.com) advises these are avoided, particularly at higher temperatures (102°F or 39°C), as the increased flow rate of the pump could cause the risk of over-dose. Scuba Diving: Medtronic (baclofenpump.com) advise against diving below 10m (33 feet).  Any patient considering SCUBA diving should discuss this with their key consultant before diving.