Table 1.

Perioperative ITB pump bridging and weaning protocol and pain management

Time to surgery	ITB dose	Oral spasticity agent	Breakthrough spasms/anti-seizure agent	Nociceptive pain agent
3 days prior to pump removal	Decreased by 10%	Baclofen 30 mg three times a day	Clonazepam 250 mcg once nightly
2 days prior to pump removal	Decreased by 20%	Baclofen 30 mg three times a day	Clonazepam 250 mcg once nightly
Day of pump removal		Baclofen 30 mg four times a day +tizanidine 2 mg twice daily	Clonazepam 500 mcg once nightly	Paracetamol 1 g four times daily +tramadol 50 mg four times daily
3 days postsurgery		Baclofen 30 mg four times a day +tizanidine 4 mg four times daily	Clonazepam 250 mcg as required	Paracetamol 1 g four times daily +tramadol 50–100 mg as required

ITB, intrathecal baclofen.