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Intravenous Lidocaine, Amantadine, and Placebo in the Treatment of Sciatica: A Double-Blind, Randomized, Controlled Study
  1. Tali Medrik-Goldberg, M.D.*,
  2. Daniel Lifschitz, M.D.*,
  3. Dorit Pud, R.N., M.A.*,,,
  4. Rivka Adler, R.N.*, and
  5. Elon Eisenberg, M.D.*,,§
  1. *From the Pain Relief Unit
  2. the Haifa Pain Research Group. Rambam Medical Center;
  3. the Ch. Spenser School of Nursing. Haifa University;
  4. §the Bruce Rappapport Faculty of Medicine, Technion—Institute of Technology, Haifa, Israel.
  1. Reprint requests: Elon Eisenberg, M.D., Pain Relief Unit. Rambam Medical Center, P.O. Box 9602, Haifa 31096, Israle.


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°; P < .05), as compared to amantadine (34-36°) and to the placebo (32-34°). All three treatments were relatively well tolerated.

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

  • lidocaine
  • amantadine
  • sciatica
  • NMDA
  • local anesthetics.

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