Intrathecal Baclofen Pump Wean and Risk of Exposure in a Large Total Body Surface Area Burn Wound Patient: A Case Report.

This article focuses on the complex medical and surgical management challenges of a 47-year-old female burn patient with a preexisting intrathecal baclofen (ITB) pump used for spasticity following a C5 spinal cord injury. The patient sustained extensive full-thickness burns overlying the ITB pump, complicating wound debridement and increasing the risk of life-threatening baclofen withdrawal due to limited medication supply and inability to safely refill or replace the device. A multidisciplinary approach was employed involving a carefully staged surgical plan to preserve tissue over the pump, a rapid but monitored baclofen weaning protocol supplemented with enteral baclofen and sedatives to prevent withdrawal, and coordinated pain management including opioid tapering. The case highlights significant institutional, legal, and clinical barriers in managing ITB pumps in burn patients and underscores the need for individualized, cautious treatment balancing wound care with device preservation and withdrawal prevention.