In this case report we present the case of a patient with cerebral palsy and the role regional nerve block played in her treatment.

A 23-year-old woman with a history of cerebral palsy with spastic quadriplegia had undergone an intrathecal baclofen pump replacement two weeks prior to presentation, which was complicated by CSF leak, requiring wound revision and was admitted back for positive OR cultures of pseudomonas and proteus.

She underwent an urgent Baclofen pump externalization and started to get weaned off with assistance from PM&R for baclofen titration and preventing withdrawal. There was difficulty in maintaining control of spasticity symptoms, with the patient developing painful contractions, fevers and tachycardia during the process.

A week later, the pump and catheter were removed at bedside.

A serratus anterior plane block was performed prior to the removal to assist with patient positioning for the procedure, analgesia for suture removal and helped alleviate spasticity symptoms.

A right-sided single shot serratus anterior and intercostal nerve blocks at the 5th rib level were performed. Local anesthetic mix was 20mL of 0.5% Bupivacaine, 20mL 0.25% Bupivacaine and 4mg Dexamethasone:

Patient had significant alleviation of her spasticity symptoms that she had been experiencing for the entire weaning process, lasting for 48 hours after the block was performed.

After removal of the intrathecal baclofen pump, she was completely transitioned to a PO regimen of baclofen and discharged home with antibiotics.

Regional nerve blocks with local anesthetics can play an important role in the management of spasticity, not only as a diagnostic test block prior to neurolysis or toxin injections; but in our described case,

Regional nerve block was effective as a bridge to alleviate symptoms during a difficult weaning process from intrathecal to PO baclofen, with 2 days of symptom control.