A 74-yr-old man was scheduled for the biopsy of prostatic
tumor under
spinal anesthesia. Preoperative serologic test for
syphilis was highly positive.
Spinal anesthesia was performed in the sitting position, and 2 ml of hyperbaric Neo-percamine S (a mixture of 0.24%
dibucaine and 0.12%
T-caine) was administered uneventfully with the onset of warm sensation on the perineal region. Ten minutes later, however, he began to complain of severe lightning sensation on the feet. After giving
pentazocine intravenously, the short cystoscopic procedure was completed. As a cause of severe
pain, an erroneous
anesthetic solution or direct neuronal injury had been excluded because of rapid and complete recovery after
anesthesia. Two weeks later, he was scheduled for TUR-P. He again complained of severe lightning
pain after the successful
spinal anesthesia with the same
anesthetic solution. Because the
pain was not relieved by
analgesics, he was then anesthetized with
enflurane and N2O in
oxygen, and there were no neurological complications after
anesthesia. Several cases of severe
pain during
spinal anesthesia have been reported in patients with
tabes dorsalis. Although the patient lacks clear symptoms of
neurosyphilis, positive serologic examination for
syphilis without any other possible causes suggests altered sensitivity of the spinal cord to
anesthetic solutions.