• Akifumi Kanai, Takashi Okamoto, Norihito Hayashi, Junko Shimao, Yuki Nagahara, and Kaoru Fujii.
• 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. kanaiakifumi@aol.com.
• Eur Spine J. 2019 Feb 1; 28 (2): 250-258.

PurposeTo investigate the safety and efficacy of intrathecal injection as an alternative to epidural injection for analgesia.MethodsSeventy 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.ResultsNo 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).ConclusionIntrathecal injection of low-dose bupivacaine offers a safe and effective treatment for chronic low back and lower extremity pain.Trial RegistrationThe 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). These slides can be retrieved under electronic supplementary material.

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