Akifumi Kanai, Takashi Okamoto, Norihito Hayashi, Junko Shimao, Yuki Nagahara, Kaoru Fujii

February 2019, Volume 28, Issue 2, pp 250 - 258 Original Article Read Full Article 10.1007/s00586-018-5801-z

First Online: 26 October 2018


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


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.


No serious adverse events were encountered. The optimal dose of bupivacaine (1.0 mg in 60% of patients) alleviated pain and disability (both, p 


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).

Graphical abstract

These slides can be retrieved under electronic supplementary material.[Figure not available: see fulltext.]

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