Intravenous lidocaine, amantadine, and placebo in the treatment of sciatica: a double-blind, randomized, controlled study.

Abstract

BACKGROUND AND OBJECTIVES:

Sciatica is a neuropathic pain syndrome caused by compression and/or inflammation of spinal nerve roots by herniated disc material, and its treatment is therefore usually aimed at reducing compression and inflammation. Studies have shown that both systemic local anesthetics and N-methyl-D-aspartate (NMDA) receptor antagonists may produce analgesia in a variety of neuropathic pain syndromes. The present study evaluated the analgesic efficacy of i.v. infusions of the local anesthetic lidocaine, the NMDA receptor antagonist amantadine, and a placebo in sciatica.

METHODS:

Thirty patients with sciatica, as confirmed by physical examination and imaging studies, were enrolled in a randomized, double-blind, three-arm crossover trial. Infusions of amantadine (2.5 mg/kg), lidocaine (5 mg/kg), and a placebo were administered over a 2-hour period, 2-7 days apart from each other. Spontaneous pain (visual analog scale) and evoked pain (straight leg raise) were measured every 30 minutes for 3 hours.

RESULTS:

Lidocaine reduced spontaneous pain as compared with amantadine and with the placebo for all measurements and at a significant level at the 30 (P < .05), 120, and 180 (P < .01) minute time points. Maximal pain reduction from the baseline was 62 +/- 7% for lidocaine, 43 +/- 7% for amantadine, and 47 +/- 7% for the placebo. Straight leg raise test also significantly improved with lidocaine (from 30 to 37 degrees; P < .05), as compared to amantadine (34-36 degrees) and to the placebo (32-34 degrees). All three treatments were relatively well tolerated.

CONCLUSIONS:

Intravenous lidocaine, rather than amantadine, reduces both spontaneous and evoked sciatic pain.

• Authors: T Medrik-Goldberg, D Lifschitz, D Pud, R Adler, E Eisenberg
• Journal: Regional anesthesia and pain medicine (Reg Anesth Pain Med) 1999 Nov-Dec Vol. 24 Issue 6 Pg. 534-40 ISSN: 1098-7339 [Print] England
• PMID: 10588558 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Analgesics, Non-Narcotic
• Anesthetics, Local
• Lidocaine
• Amantadine

Topics

• Adolescent
• Adult
• Amantadine (adverse effects, therapeutic use)
• Analgesics, Non-Narcotic (adverse effects, therapeutic use)
• Anesthetics, Local (adverse effects, therapeutic use)
• Double-Blind Method
• Drug Therapy, Combination
• Female
• Humans
• Injections, Intravenous
• Lidocaine (adverse effects, therapeutic use)
• Male
• Middle Aged
• Sciatica (drug therapy)