High intrathecal bupivacaine for severe pain in the head and neck

Background: Severe pain in the head and neck is associated with a lowered quality of life and conventional pain therapy often does not provide adequate relief. The aims of this study were to investigate the efficacy, pain relief, benefits and adverse effects of intracisternal or high cervical (IHC) administration of bupivacaine in patients with severe pain in the head, neck and face regions. Methods: Between 1990 and 2005, 40 patients (age 27‐84 years) were treated with continuous IHC infusions of bupivacaine for various non-cancer (n 5 15) or cancerrelated (n 5 25) refractory pain conditions (duration 1 month‐18 years) in the head, neck, mouth and shoulder regions. Results: Visual analogue scale scores and opioid requirements decreased markedly after the start of the treatment and remained lowered throughout the study. No tachyphylaxis for bupivacaine was observed. Major side effects were few and most often transient. Most patients showed unchanged or improved mobility. There was no mortality, neurological damage or other severe events attributable to procedures in the study protocol. Conclusion: For patients with severe and refractory pain in areas innervated by cranial and upper cervical nerves, cervical high spinal analgesia can provide safe and effective analgesia.