【原】【罂粟摘要】复杂局部疼痛综合征患者交感神经阻滞后体温升高与疼痛缓解的相关性

复杂局部疼痛综合征患者交感神经阻滞后体温升高与疼痛缓解的相关性

贵州医科大学  麻醉与心脏电生理课题组

翻译：张中伟  编辑：王婷婷  审校：曹莹  

目的： 确定交感神经阻滞后温度变化与近期和中期疼痛缓解之间的相关性。

设计： 回顾性分析。

设置： 学术环境。

目标： 79例接受交感神经阻滞的复杂区域疼痛综合征患者。

方法： 记录肢体的阻滞前和阻滞后温度以及即时（基于6小时疼痛日记）疼痛评分，并在4至8周随访记录。阻滞后疼痛减轻30-49%和≥50%分别被定义为为部分交感维持疼痛和交感维持疼痛。疼痛评分下降≥2分持续≥4周被认为是交感神经阻滞的阳性中期结局。

结果： 短期的疼痛缓解和队列的温度升高程度之间的相关性很弱（R = 0.192，P=0.043）。据报道，体温升高≥7.5°C（平均 4.1;95% 置信区间 [CI]：3.33 至 4.76）的患者比体温升高<2°C（2.3;95% CI：1.36 至 3.31或≥2°C至<7.5°C（2.9;95% CI：1.8至3.9;P=0.036）的患者近期疼痛减轻程度更高、4-8周时体温升高与中期疼痛评分降低（R= 0.052，P=0.329）以及短期期和中期疼痛缓解（R=0.139，P=0.119）之间的相关性无统计学意义。

结论： 在阻滞后局部温度升高与即时疼痛缓解的人中发现的弱相关性。可能需要使用高于常使用的温度升高阈值，以确定复杂区域疼痛综合征患者是否有交感神经维持的疼痛。

原始文献来源：Samen C D K, Sutton O M, Rice A E, et al. Correlation Between Temperature Rise After Sympathetic Block and Pain Relief in Patients with Complex Regional Pain Syndrome[J]. Pain Medicine, 2022, 23(10): 1679–1689.

Correlation Between Temperature Rise After Sympathetic Block and Pain Relief in Patients with Complex Regional Pain Syndrome

Objective: Determine the correlation between post-sympathetic block temperature change and immediate- and intermediate-term pain relief.

Design: Retrospective analysis. 

Setting: Academic setting.

Subjects: Seventy-nine patients with complex regional pain syndrome who underwent sympathetic block.

Methods: Pre- and post-block temperatures in the affected extremity and pain scores immediately (based on 6-hour pain diary) after the block and at the intermediate-term 4- to 8-week follow-up were recorded. Post-block pain reductions of 30-49% and ≥50% were designated as partially sympathetically maintained pain and sympathetically maintained pain, respectively. A decrease in pain score ≥2 points lasting ≥4 weeks was considered a positive intermediate-term outcome for sympathetic block.

Results: A weak correlation was found between immediate-term pain relief and the extent of temperature rise for the cohort (R = 0.192, P = 0.043). Greater immediate-term pain reduction was reported among patients who experienced a temperature increase ≥7.5°C (mean 4.1; 95% confidence interval [CI]: 3.33 to 4.76) than among those who experienced a temperature increase <2°C (2.3; 95% CI: 1.36 to 3.31) or ≥2°C to <7.5°C (2.9; 95% CI: 1.8 to 3.9; P = 0.036). The correlations between temperature increase and intermediate-term pain score reduction at 4-8 weeks (R = 0.052, P = 0.329) and between immediate- and intermediate-term pain relief (R = 0.139, P = 0.119) were not statistically significant.

Conclusions: A weak correlation was found for those who experienced greater temperature increases after the block to also experience greater immediate pain relief. Higher temperature increase cutoffs than are typically used might be necessary to determine whether a patient with complex regional pain syndrome has sympathetically maintained pain.