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Total spinal anesthesia provides transient relief of intractable pain

[La rachianesthésie totale permet un soulagement passager de la douleur rebelle]

From the Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan.

Dr. Masataka Yokoyama, Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine and Dentistry, 2-5-1, Shikata-cho, Okayama City, Okayama 700-8558, Japan. Phone and Fax: 81-86-235-7778; E-mail: masayoko{at}cc.okayama-u.ac.jp

Purpose: 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: iv infusion with 300 mg of lidocaine (iv-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 iv-Lido treatment. VAS were similar before both treatments (87 ± 6 for TSA-Lido; 86 ± 7 for iv-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.

Conclusion: Intractable pain was decreased significantly for several days after TSA, but pain-relief was not sustained.