Managing spasticity in spinal cord injury: Safe administration of bridge boluses during intrathecal baclofen pump refills

Intrathecal baclofen now plays an important role in the management of spasticity in a number of neurologic conditions including spinal cord disorders. Dosage errors can be a source of significant morbidity and the risk is greatest when the clinician is changing solution concentration. When changing concentrations, it is imperative to program the pump correctly by incorporating a bridge bolus to compensate for the residual baclofen solution in the pump and catheter. This paper reviews the appropriate methods to safely calculate the bridge bolus, with an illustrative example.