Intrathecal prednisolone sodium succinate with lidocaine for intractable postherpetic neuralgia

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  • KUROKAWA Hiromi
    Department of Anesthesiology and Critical Care Medicine, Hiroshima University Faculty of Medicine
  • MORIWAKI Katsuyuki
    Department of Anesthesiology, National Hospital Kure Medical Center
  • SAEKI Noboru
    Division of Surgery, Hiroshima Univesity Hospital
  • KUSUNOKI Shinji
    Division of Surgery, Hiroshima Univesity Hospital
  • KAWAMOTO Masashi
    Department of Anesthesiology and Critical Care Medicine, Hiroshima University Faculty of Medicine
  • YUGE Osafumi
    Department of Anesthesiology and Critical Care Medicine, Hiroshima University Faculty of Medicine

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Other Title
  • 帯状疱疹後神経痛に対するコハク酸プレドニゾロンを用いたくも膜下ステロイド治療
  • ショウレイ タイジョウホウシンゴ シンケイツウ ニ タイスル コハクサン プレドニゾロン オ モチイタク モ マク カ ステロイド チリョウ リドカイン ヘイヨウ ノ ユウヨウセイ ト モンダイテン

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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.

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