Severe Lightning Pain After Subarachnoid Block in a Patient With Neuropathic Pain of Central Origin: Which Drug Is Best to Treat the Pain?

• Published in: The Clinical journal of pain Vol. 16; no. 3; pp. 265 - 269
• Main Authors: Wajima, Zen'ichiro, Shitara, Toshiro, Inoue, Tetsuo, Ogawa, Ryo
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-09-2000; Lippincott Williams and Wilkins
• Subjects: Analgesics - therapeutic use; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Central Nervous System Diseases - complications; Humans; Local anesthesia. Pain (treatment); Male; Medical sciences; Middle Aged; Nerve Block - adverse effects; Pain - drug therapy; Pain - etiology; Pain Measurement; Spinal Cord Injuries - complications; Subarachnoid Space; Human; Thiopental sodium; Blocking; Male; Sudden; Neuropathy; Intrathecal administration; Case study; Regional anesthesia; Analgesic; Pain; Treatment; Anesthetic; Subarachnoid; Adult; Complication; Barbiturates
• ISSN: 0749-8047; 1536-5409
• DOI: 10.1097/00002508-200009000-00013

OBJECTIVE:There have been many reports that spinal anesthesia induces severe lightning pain in the lower limbs of patients with phantom limb pain, tabes dorsalis, or causalgia. We report on a patient with neuropathic pain of central origin who showed newly developed severe lightning pain after therapeutic subarachnoid block (SAB). We performed SAB 16 times in this patient, and he complained of severe pain each time. We investigated which drug was best for treating such induced pain by administering various drugs to the patient.
SETTING:The patient was hospitalized for treatment and observation.
PATIENT:The patient was a 48-year-old man with neuropathic pain secondary to an incomplete spinal cord injury at the cervical segment.
INTERVENTIONS:Various drugs were administered for relieving the newly developed severe pain, and the effectiveness of these agents was compared.
RESULTS AND CONCLUSIONS:Intravenous thiopental, fentanyl, butorphanol, ketamine, midazolam, droperidol, and sevoflurane-oxygen anesthesia were quite effective. Intramuscular butorphanol was not effective. Intravenous physiologic saline and atropine sulfate as a placebo, intrathecal morphine hydrochloride, intravenous mexiletine, and lidocaine were ineffective. Intravenous thiopental (approximately 1 mg/kg) was thought to obtain the best pain relief because it stopped the pain quickly, the dose needed was subanesthetic, and there was no adverse effect.