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Short-term results of intrathecal injection of low-dose bupivacaine in outpatients with chronic low back and lower extremity pain

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Abstract

Purpose

To investigate the safety and efficacy of intrathecal injection as an alternative to epidural injection for analgesia.

Methods

Seventy consecutive outpatients with chronic low back and lower extremity pain received lumbar intrathecal injection of low-dose isobaric bupivacaine using a 25-gauge pencil-point needle. The patients received 0.5, 1.0, and 1.5 mg of bupivacaine at 1-week intervals to determine the optimal dose. Thereafter, they received two more weekly injections with the optimal dose. The safety and efficacy of the treatment were assessed over a 1-year period.

Results

No serious adverse events were encountered. The optimal dose of bupivacaine (1.0 mg in 60% of patients) alleviated pain and disability (both, p < 0.0001) and provided anesthesia below L1 (L5–T6). Motor block was negligible, and balance impairment improved relative to baseline (p < 0.0001).

Conclusion

Intrathecal injection of low-dose bupivacaine offers a safe and effective treatment for chronic low back and lower extremity pain.

Trial registration

The study was approved by the Kitasato University Hospital Ethics Committee, and written informed consent was obtained from all individual participants included in the study. This trial was registered with the University Hospital Medical Information Network (UMIN000008670).

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Authors and Affiliations

  1. Department of Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan

    Akifumi Kanai

  2. Department of Anaesthesiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan

    Takashi Okamoto, Norihito Hayashi, Junko Shimao & Yuki Nagahara

  3. Department of Diagnostic Radiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan

    Kaoru Fujii

Authors
  1. Akifumi Kanai
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  2. Takashi Okamoto
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  3. Norihito Hayashi
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  4. Junko Shimao
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  5. Yuki Nagahara
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  6. Kaoru Fujii
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Corresponding author

Correspondence to Akifumi Kanai.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All study procedures performed in human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the study.

Electronic supplementary material

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Cite this article

Kanai, A., Okamoto, T., Hayashi, N. et al. Short-term results of intrathecal injection of low-dose bupivacaine in outpatients with chronic low back and lower extremity pain. Eur Spine J 28, 250–258 (2019). https://doi.org/10.1007/s00586-018-5801-z

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  • DOI: https://doi.org/10.1007/s00586-018-5801-z

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