【原】静脉输注利多卡因提高传统治疗带状疱疹后神经痛的疗效

静脉输注利多卡因提高传统治疗带状疱疹后神经痛的疗效

贵州医科大学  麻醉与心脏电生理课题组

翻译：刘云琴   编辑：陈锐   审校：曹莹

01

背景

带状疱疹后神经痛(PHN)是一种严重的神经性疼痛，目前还不能被有效治愈。近期研究表明，静脉输注利多卡因可以有效治疗神经性病理性疼痛如PHN;然而，但对于PHN患者，利多卡因输注的最佳剂量和频率以及该治疗的有效性和安全性仍需更多的临床研究。本研究的目的是评估每日静脉注射利多卡因对PHN常规治后的疗效的影响。

02

方法

将60例PHN患者随机分为两组:1)对照组，给予常规治疗，如抗癫痫丸、镇痛药、神经营养药物、椎旁脊髓神经阻滞及物理治疗;2)利多卡因组(利多卡因组)在常规治疗基础上给予利多卡因每日滴注4mg /kg。如果疼痛没有得到充分控制，则额外给予曲马多，并计算曲马多的平均消耗量。评估每次输注前后的疼痛强度，记录最近24小时内疼痛突破次数。记录利多卡因静脉滴注相关不良反应发生情况。

03

结果

连续5天，数值评分量表(NRS)评分在利多卡因静脉滴注1小时后显著降低。与对照组相比，利多卡因组患者的NRS评分和爆发疼痛的频率均显著降低。此外，利多卡因组的曲马多额外消耗量明显低于对照组，患者的平均住院时间也有所下降。然而，焦虑和抑郁得分在利多卡因组和对照组之间没有差异。

04

结论

每日静脉注射利多卡因(4mg /kg，连续5天)可提高PHN治疗效果，减少镇痛药用量，缩短病程住院期间没有明显的副作用。

05

原始文献来源

Tan X ,  Ma L ,  Yuan J , et al. Intravenous infusion of lidocaine enhances the efficacy of conventional treatment of postherpetic neuralgia[J]. Journal of Pain Research, 2019, 12.

英文原文

Intravenous infusion of lidocaine enhances the effificacy of conventional treatment of postherpetic neuralgia

Background:  Postherpetic neuralgia (PHN) is one kind of severe neuropathic pain which currently can not be effectively cured. Recent researches suggest that intravenous infusion of lidocaine has a therapeutic effect on neuropathic pain such as PHN; however, the optimal dose and frequency of lidocaine infusion and the effectiveness and safety of this treatment in PHN patients still needs more clinical research. The aim of this study was to evaluate the therapeutic effects of daily intravenous lidocaine infusion on the outcome of the routine treatment of PHN.

Methods: Sixty PHN patients were randomly divided into two groups: 1) control group (Control), treated with conventional therapies, such as antiepileptic pills, analgesics, neurotrophic medicines, paravertebral spinal nerve block and physiotherapy; 2) lidocaine group (Lido) received daily infusion of lidocaine (4 mg/kg) besides the conventional treatments. If the pain is not controlled sufficiently, additional tramadol is given and the average consumption of tramadol is calculated. Pain intensity was assessed before and after each infusion, and the number of breakthrough pain in the last 24 hrs were recorded. The incidence of adverse reactions related to intravenous lidocaine infusion was recorded。

Results:For five consecutive days, numeric rating scale (NRS) scores were significantly  decreased after 1 hr of intravenous infusion of lidocaine. Compared with Control, the NRS scores and the frequency of breakthrough pain in the Lido were significantly reduced. In addition, the extra tramadol consumption in the Lido was significantly lower than that in the Control, and the average hospital stay of patients in Lido was decreased. However, anxiety and depression scores showed no difference between Lido and Control.

Conclusions: Daily intravenous lidocaine (4 mg/kg for 5 days) enhanced the outcome of PHN treatment, reduced the amount of analgesic medicine and shortened the length of hospital stay with no obvious adverse side effects.

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