The intrathecal injection of low-dose bupivacaine proved to be as a safe and effective treatment for chronic low back and lower extremity pain as concluded in the 'European Spine Journal'. Akifumi Kanai et al. assessed the safety and efficacy of intrathecal injection as a substitute to epidural injection for chronic pain management.

A total of 70 consecutive outpatients with chronic low back and lower extremity pain received a lumbar intrathecal injection of low-dose isobaric bupivacaine via a 25-gauge pencil-point needle. To find out the optimal dose, the patients received 0.5, 1.0, and 1.5 mg of bupivacaine at 1-week intervals. Afterwards, they were again administered with two more weekly optimal dose injections. The safety and efficacy of the treatment were examined over the 1-year duration.

It was found that there were no serious adverse events. The optimal dose of bupivacaine (1.0 mg in 60% of patients) attenuated pain and disability and provided anaesthesia below L1 (L5–T6). The motor block was negligible, and balance impairment improved relative to baseline.