Total spinal anesthesia provides transient relief of intractable pain.
OBJECTIVE
Intentional total spinal anesthesia (TSA) has been used for intractable pain treatment. However, the long-term effect of pain-relief is controversial. We investigate the short- and long-term effects of pain-relief by TSA.


METHODS
Twelve patients with intractable pain participated in a crossover study. All participants received two different treatments in random order at a 30-day interval: i.v. infusion with 300 mg of lidocaine (i.v.-Lido), and TSA with 20 mL of 1.5% lidocaine (TSA-Lido). Pain level at rest was scored with the visual analogue scale (VAS: 0-100), and blood pressure and heart rate were measured before and at two hours, 24 hr, seven days, and 30 days after treatment. Plasma lidocaine concentrations were measured at 0.5, one, and two hours.


RESULTS
Heart rate and mean arterial pressure during or after TSA-Lido were similar to those before TSA-Lido. Plasma lidocaine concentrations were similar between the two treatments. No significant difference in any value occurred in the i.v.-Lido treatment. VAS were similar before both treatments (87 +/- 6 for TSA-Lido; 86 +/- 7 for i.v.-Lido). After TSA-Lido, VAS decreased significantly until day seven (two hours, 17 +/- 22, P < 0.01; 24 hr, 43 +/- 20, P < 0.01; seven days, 66 +/- 16, P < 0.01). However, VAS returned to the pre-block values 30 days after TSA-Lido.


CONCLUSIONS
Intractable pain was decreased significantly for several days after TSA, but pain-relief was not sustained.
Yokoyama
Masataka
M
Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan. masayoko@cc.okayama-u.ac.jp
Itano
Yoshitaro
Y
Kusume
Yoshio
Y
Oe
Katsunori
K
Mizobuchi
Satoshi
S
Morita
Kiyoshi
K
D000328:Adult; D000368:Aged; D000775:Anesthesia, Spinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010148:Intractable Pain / Q000628:therapy*