【原】【罂粟摘要】利多卡因注射液治疗难治性慢性偏头痛的回顾性分析

利多卡因注射液治疗难治性慢性偏头痛的回顾性分析

贵州医科大学  麻醉与心脏电生理课题组

翻译：安丽   编辑：潘志军   审校：曹莹

01

背景

难治性慢性偏头痛患者的生活质量较差。静脉输注利多卡因可有效缓解疼痛并打破该疼痛循环，但相关的依据有限。

02

方法

本研究对832例连续多日注射利多卡因治疗偏头痛的住院记录进行了回顾。所有患者均符合难治性慢性偏头痛的标准。住院期间，患者接受了额外的偏头痛药物，包括酮咯酸、镁、二氢麦角胺、甲基强的松龙和神经阻滞剂。主要转归是从基线检查到出院此期间头痛疼痛的变化。次要结果为出院后就诊(治疗后25 ~ 65天)包括头痛、头痛天数和持续发生率。同时测定了急性反应者的百分比、血浆利多卡因水平和药物不良反应情况。

03

结果

对符合标准的609名患者纳入了研究。平均年龄46±14岁；81.1%是女性。疼痛中位数评分从基线检查时的7.0分下降住院结束时（5.0–8.0）至1.0（0.0–3.0）分（p＜0.001）；急性反应者有87.8%。门诊的平均疼痛（261例）仍低于基线水平访问1（5.5（4.0–7.0）；p＜0.001）。43%的患者在第1个月有持续反应。头痛天数（N=266）从26.8±3.9天减少到出院后就诊时基线检查为22.5±8.3（p＜0.001）。恶心和呕吐是最常见的药物不良反应，且都是轻微的。

04

结论

在难治性慢性偏头痛中，利多卡因注射液可能与短期和中期疼痛缓解有关。可设计前瞻性研究进一步证实此结果。

5

原始文献来源

Eric S Schwenk ,Aaron Walter,Marc C Torjman,Sarah Mukhtar,Harsh T Patel,Bryan Nardone,George Sun ,Bhavana Thota,Clinton G Lauritsen,Stephen D Silberstein.Lidocaine infusions for refractory chronic migraine: aretrospective analysis.Schwenk ES, et al. Reg Anesth Pain Med 2022;47:408–413. doi:10.1136/rapm-2021-103180.

英文原文

Lidocaine infusions for refractory chronic migraine: a

retrospective analysis  

Abstract

Introduction Patients with refractory chronic migraine have poor quality of life. Intravenous infusions are indicated to rapidly ’break the cycle’ of pain. Lidocaine infusions may be effective but evidence is limited.

Methods The records of 832 hospital admissions involving continuous multiday lidocaine infusions for migraine were reviewed. All patients met criteria for refractory chronic migraine. During hospitalization, patients received additional migraine medications including ketorolac, magnesium, dihydroergotamine, methylprednisolone, and neuroleptics. The primary outcome was change in headache pain from baseline to hospital discharge. Secondary outcomes measured at the post-discharge office visit (25–65 days after treatment) included headache pain and the number of headache days, and percentage of sustained responders. Percentage of acute responders, plasma lidocaine levels, and adverse drug effects were also determined.

Results In total, 609 patient admissions met criteria. The mean age was 46±14 years; 81.1% were female. Median pain rating decreased from baseline of 7.0 (5.0–8.0) to 1.0 (0.0–3.0) at end of hospitalization (p<0.001); 87.8% of patients were acute responders. Average pain (N=261) remained below baseline at office visit 1 (5.5 (4.0–7.0); p<0.001). Forty-three percent of patients were sustained responders at 1month.Headache days (N=266) decreased from 26.8±3.9 at baseline to 22.5±8.3 at the post-discharge office visit (p<0.001). Nausea and vomiting were the most common adverse drug effects and all were mild.

Conclusion Lidocaine infusions may be associated with short-term and medium-term pain relief in refractory chronic migraine. Prospective studies should confirm these results.

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