Relief of Pain by Intrathecal Injection of Hypothermic Saline

Nicholson, Margaret F.; Roberts, F. W.

doi:10.5694/j.1326-5377.1968.tb27469.x

Cited by 8 publications

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“…Hitchcock (1967a, b) introduced subarachnoid irrigation with cold solutions for the relief of intractable pain and subsequently inquired into the hyperosmolarity of his solution. Ensuing clinical research explored the use of anaesthesia (Nicholson and Roberts, 1968;Collins, Juras, and Van Houten, 1969), varying sites of injection (Hitchcock, 1969;Mathews, Ambruso, and Osterholm, 1970), prolonged irrigation (Tsubokawa, 1969a), increasingly hypertonic saline (Hitchcock, 1970), and elaborate perfusion apparatus (Negrin, 1970). To our knowledge, no previous investigators have reported the primary results of brief intrathecal injection of isotonic iced saline.…”

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Intractable pain treated with intrathecal isotonic iced saline

Savitz

Malis

1973

Journal of Neurology, Neurosurgery & Psychiatry

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SUMMARY Hitchcock's original method of hypothermic subarachnoid irrigation employed both temperature and osmolarity. Spinal cooling was then abandoned in favour of intrathecal injection of normothermic hypertonic saline. Modifications of the procedure that followed have continued to accept hyperosmolarity as the factor causing pain relief. Fifty patients were treated by a technique evolved to enhance the effect of hypothermia while avoiding the complications associated with hyperosmolar solutions. For the cases of terminal carcinoma and others considered to be poor surgical risks, the results have been quite satisfactory. For non-neoplastic painful syndromes, rapid perfusion cooling of the subarachnoid space offers an alternative therapeutic approach.The effects of hypothermia on the nervous system (Denny-Brown, Adams, and Brenner, 1945) (Hitchcock, 1969;Mathews, Ambruso, and Osterholm, 1970), prolonged irrigation (Tsubokawa, 1969a), increasingly hypertonic saline (Hitchcock, 1970), and elaborate perfusion apparatus (Negrin, 1970). To our knowledge, no previous investigators have reported the primary results of brief intrathecal injection of isotonic iced saline. METHODThe irrigating solution was prepared by keeping 500 ml. pour bottles of sodium chloride injection (U.S.P.) in the freezer of an ordinary refrigerator until ice cubes formed in a separate tray. During the procedure, a small bucket filled with crushed ice maintained the temperature in the bottle between 0°and -1 C ('hypothermic solution'). Analysis of our iced saline failed to reveal any increase in osmo-417 larity: 308 m-osmol/l., consisting of 154 m-equiv/l. sodium and 154 m-equiv/l. chloride.The patient was placed on a tilting table in the lateral position for lumbar tap with a 16 gauge spinal needle. Cerebrospinal fluid was allowed to flow out spontaneously until subambient pressure was produced. Mechanical withdrawal by syringe was specifically avoided to prevent aspiration of a nerve root or alteration of the needle tip within the subarachnoid space.When the pain was unilateral, the patient remained with the affected side down. When the pain was bilateral or midline, the patient was placed in the prone position. The

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