Abstract
Neo Vitacain INJECTION® (Neo Vitacain) is an analgesic preparation containing dibucaine hydrochloride (0.1 %), sodium salicylate (0.3 %) and calcium bromide (0.2 %). We report prolonged paralysis in two patients after accidental intrathecal injection of Neo Vitacain. Case 1: A 65-year-old man with lumbar disc herniation had low back pain. Trigger point injection with Neo Vitacain (5 ml) and betamethasone (2 mg) was performed into the tender point around the right L4/5 facet joint. Caudal block with 1 % mepivacaine was performed 2 minutes after the trigger point injection. Aspiration for cerebrospinal fluid (CSF) was negative for both procedures. The patient reported warm sensation in both legs during caudal block. Complete paralysis of the lower limbs occurred in 10 minutes. Neo Vitacain was suspected to be injected intrathecally. The paralysis resolved 16 hours after the blocks. Case 2: A 25-year-old woman with complex regional pain syndrome of the left leg received injection of 5 ml of Neo Vitacain into the presumable epidural space through the L3/4 intervertebral space. Complete paralysis of the lower limbs occurred in a few minutes. The paralysis resolved in 11 hours after the block. We should be careful when we inject Neo Vitacain around the paravertebral region and into the epidural space, since accidental intrathecal injection of Neo Vitacain can cause prolonged paralysis.
