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Painless intrathecal hypertonic saline

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Summary

Hypertonic saline, when injected into the lumbar subarachnoid space for the relief of intractable pain, causes pain, unpleasant muscle cramps and potentially dangerous sympathetic discharge. These side effects can be avoided by adding a weak concentration of local anaesthetic to the brine solution. Fourteen intrathecal injections of 8 per cent sodium chloride and 0.4 per cent lidocaine (osmolality: 2788 m.Osmols/Kg) were made in 9 patients. Serial measurements of cerebrospinal fluid osmolality and chloride content were made during the succeeding 15 minutes. Cerebrospinal fluid osmolality increased four to eight-fold shortly after injection, and was still thrée to six times higher than normal 15 minutes later. The procedure was painless, and frée of cardiovascular disturbances.

Résumé

Lorsqu’injecté dans l’espace sous-arachnoidien lombaire pour le soulagement de la douleur incoercible, le sérum salé hypertonique occasionne de la douleur, des crampes musculaires désagréables et des impulsions sympathiques virtuellement dangereuses. Ces effets secondaires peuvent être évités en ajoutant à la solution salée une faible concentration d’anesthésique local. Quatorze injections intrathécales de chlorure de sodium à 8 pour cent et de lidocaine à 0.4 pour cent (osmo-lalité: 2788 mOsmols/Kg) furent faites chez 9 malades. Des mesures en série de l’osmolalité du liquide céphalo-rachidien et de son contenu en chlorure furent faites au cours des 15 minutes subséquentes. L’osmolalité du liquide céphalorachidien augmenta de quatre à huit fois peu de temps après l’injection, et s’avérait encore de trois à six fois au-delà de la normale 15 minutes plus tard. Ce procédé se montra indolore et dénué de perturbations cardio-vasculaires.

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Author information

Correspondence to A. W. Squire or O. Calvillo or P. R. Bromage.

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Squire, A.W., Calvillo, O. & Bromage, P.R. Painless intrathecal hypertonic saline. Canad. Anaesth. Soc. J. 21, 308–314 (1974). https://doi.org/10.1007/BF03005735

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Keywords

  • Hypertonic Saline
  • Chloride Content
  • Intractable Pain
  • Cerebrospinal Fluid Pressure
  • Cent Lidocaine