Low-Dose Intravenous Lidocaine as Treatment for Proctalgia Fugax Roni Peleg, M.D., and Pesach Shvartzman, M.D. Background: Proctalgia fugax is characterized by a sudden internal anal sphincter and anorectic ring attack of pain of a short duration. Objective: Description of the influence of intravenous lidocaine treatment for proctalgia fugax. Case Report: A 28-year-old patient suffering of proctalgia fugax for 8 months. Conventional treatment efforts did not improve his condition. A single dose of an intravenous lidocaine infusion completely stopped his pain attacks. Conclusions: Based on the experience reported in this case and the potential benefit of this treatment for proctalgia fugax, controlled studies comparing intravenous lidocaine with placebo should be conducted to confirm the observation and to provide a more concrete basis for the use of intravenous lidocaine for this indication. Reg Anesth Pain Med 2002;27:97-99. Key Words: Proctalgia fugax, Intravenous lidocaine. P roctalgia fugax is characterized by sudden in- ternal anal sphincter and anorectal ring attacks of intense pain. The pain is typically unrelated to defecation, usually lasts for less than 20 minutes, appears spontaneously, and often awakens the pa- tient from sleep. In extreme cases the pain can last for many hours, vanish, and then return again. 1 Treating proctalgia fugax is difficult, and no single therapeutic approach is completely successful. It is still a frustrating entity for many patients and their physicians. We describe a patient who suffered from prolonged intractable symptoms of proctalgia fugax. The pain was completely relieved after ad- ministration of a single intravenous (IV) lidocaine infusion. Case Report A 28-year-old man complained of anal pain that began 8 months before his first visit. The attacks lasted only a few minutes. It occasionally caused the patient to awaken at night. There were no changes in the defecation habits or weight. In the 2 months before his initial visit the attacks came more often, for short intervals every day, especially at night, and at a higher intensity, described on a visual analog scale (VAS) as 7 to 8/10. External observa- tion and digital examination of the rectum was normal. No pathology was seen on rectoscopy, and the barium enema examination was normal. The working diagnosis was proctalgia fugax. During the 2 months following the patient’s initial clinic visit, 8 office visits were recorded for the same problem. The patient was treated with hot baths, antispas- modics such as spasmalgin (a combination of atro- pine 0.4 mg, papaverin HCl 80 mg, paracetamol 150 mg, codeine phosphate 10 mg) 3 times a day, and inhalations of salbutamol 0.5 mL (2.5 mg) with 2 mL saline initially, followed a few days later by 1 mL (5 mg) with 2 mL saline. No calcium antagonists were tried. Each treatment was prescribed sepa- rately and administered in intervals of a few days apart, though no improvement in his condition was noted. After 1 month of these treatment trials, and after 1 week of not receiving any treatment, the patient again complained of an increased intensity of the pain attacks. This time the patient was treated with an IV infusion of lidocaine (1 mg/kg) in saline solution as a single dose over a period of 30 min- utes; no pain attacks occurred during the treatment. After this treatment the pain ceased completely. From the Department of Family Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Is- rael. Accepted for publication June 19, 2001. Reprint requests: Roni Peleg, M.D., Department of Family Medicine, Ben Gurion University of the Negev, PO Box 653, Beer-Sheva, 84105, Israel. E-mail: pelegr@bgumail.bgu.ac.il © 2002 by the American Society of Regional Anesthesia and Pain Medicine. 1098-7339/02/2701-0109$35.00/0 doi:10.1053/rapm.2002.27839 Regional Anesthesia and Pain Medicine, Vol 27, No 1 (January–February), 2002: pp 97–99 97