Intrathecal prednisolone sodium succinate with lidocaine for intractable postherpetic neuralgia

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Intrathecal injection of prednisolone sodium succinate is approved in Japan for treatment of such diseases as encephalomyelitis, central nervous system leukemia and malignant lymphoma. We gave a total of 16 intrathecal prednisolone sodium succinate injections (each, 40mg dissolved in 2-3ml of 3% lidocaine) to six patients with intractable postherpetic neuralgia, and reviewed the therapeutic utility and complications. The median visual analogue scale pain-intensity score decreased significantly, from 55mm to 35mm, after the treatment (p<0.05). Ephedrine hydrochloride was necessary in 14 of the 16 injections, to treat hypotension. In addition, respiratory depression from a high level of spinal anesthesia and sedation occurred 11 times and required assisted ventilation, while diazepam was given 9 times for treatment and prevention of local anesthetic adverse effects on the central nervous system. We conclude that intrathecal prednisolone sodium succinate injection therapy is useful for intractable postherpetic neuralgia patients, however, side effects caused by the solvent lidocaine occurred frequently. Therefore, we consider it important to perform this method with careful monitoring.
一般社団法人日本ペインクリニック学会の論文