EFFICACY OFlINTRAVENOUS SHLOROPROCAINE FOR CHRONIC PAfN. R.D. France , B.J. Urban .

Departments of Psychiatry and AnesthesiologyL,Duke University Medical Center, Durham, North Carolina 27710, USA. Aim of Investigation: Intravenously (i.v.) administered local anesthetics have been reported to modulate various painful conditions. In particular, chloroprocainehas been observed to produce lasting pain reduction in a majority of patients. This presentation describes the incidence, degree and duration of pain reduction which has occurred in our chronic pain patients after i.v. chloroprocaine. Methods: During 1985/86 46 patients with chronic daily pain despite extensive multidisciplinarytherapy were offered i.v. chloroprocaine treatment. This drug was administered slowly i.v. (10 mg/kg). Injection was repeated up to 3 times if partial pain relief persisted for 24 hours and the 2nd injection produced further pain reduction. If no pain moderation was apparent 24 hours after the first treatment, further injections were not given. Pain relief was assessed by sequential categorical (CS), McGill Pain Questionnaire (MPQ), and visual analogue scaling (VAS) following each treatment and at suitable intervals. Results: 16 patients (34%) experienced pain relief lasting between 1 and 6 or more months (mean 3.8 months) following i.v. chloroprocaine. All,except 1 patient with facial pain had sciatica with burning segmental dysesthesia. Pain reduction was judged to be between 75-99X (9 patients), 50-742 (6 patients), and 25-49% (1 patient). This was substantiatedby MPQ and VAS ratings. There were no lasting side effects from treatment. In 7 patients the procedure was repeated when pain recurred and became the major therapy. Conclusions: I.v. chloroprocaine is a valuable adjunct in the management of certain patients with chronic pain.

THE EFFECT OF SYSTEMIClLIDOCAINE ONlNOCICEPTIVE ;Fri;qBETICS. F.,W.BacQ , T.S.Jensen , B. Stigsby: and and A.De$qaard , Departments of Neurology Neurophysiology , Gentofte Hospi,tal, Department of clinical Physiology, Bispebjerg Hospital , University of Copenhagen and Hvidmre Hospital , Denmark. Aim of investigation: Systemic administration of the local anaesthetic lidocaine reduces pain in diabetic neuropathies. The mechanism underlying the analgetic effects is not clear. Both peripheral and central actions have been proposed. Previous studies indicate that systemic administration of lidocaine produces a selective central block of noxious evoked activity in the rat spinal cord. We studied the effect of systemic lidocaine on the peripheral cutaneous thermal sensitivity and on the spinal mediated nociceptive flexor refleks (NFR) in diabetics. Methods: Eight diabetics with known neuropathy and painful distal dysaesthesias received in a double-blind controlled study with cross-over design an i.v. infusion of lidocaine 5 mg/kg or saline in 30 min. Thermal sensibility was quantified by a thermotest (Somedic AB). Cold pain threshold (CP), heat pain threshold (HP) and warm-cold discrimination interval (WC) was determined in hand and foot before, immediately after and lo days after infusion. At the same time the NFR-threshold was determined by sural nerve electrical stimulation recording from biceps femoris muscle. Results: No effect of lidocaine was found on CP, HP or WC. It was only possible to establish a NFR threshold prior to infusion in 3 patients. In these patients lidocaine either abolished or increased the threshold immediately after infusion. The threshold returned to control levels within lo days. Conclusions: Our findings do not support effect on peripheral nerve fibers, lidocaine in diabetic neuropathy. but favour an effect on spinalleve1ofi.v.