文献-镇痛||A型肉毒毒素的镇痛效果

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文献-镇痛||A型肉毒毒素用于腰交感神经节阻滞治疗复杂区域性疼痛综合征

A型肉毒素用于腰交感神经节阻滞治疗复杂区域性疼痛综合征：一项随机试验

&背景：&

本研究旨在验证肉毒素通过持续升高皮肤温度延长腰交感神经阻滞持续时间的假设。作者进行了一项随机、双盲、对照试验，研究a型肉毒素治疗复杂区域性疼痛综合征患者腰交感神经节阻滞的临床疗效。

&方法：&

采用75 IU A型肉毒素（肉毒素组）和局部麻醉药（对照组），对下肢复杂区域性疼痛综合征患者进行腰交感神经节阻滞。

主要结果是1个月后阻滞侧足底与对侧足底的相对温差变化。

次要结果是3个月后的相对温差变化以及疼痛强度变化。

&结果：&

共有48名参与者（N=24/组）被随机分配。

肉毒素组的相对温度增加高于对照组（分别为1.0±1.3℃ vs. 0.1±0.8℃；差异：0.9℃[95%CI：0.3～1.5]；P=0.006）。

维持至术后3个月，为1.1±0.8 ℃ vs.-0.2±1.2 ℃；P=0.009。

此外，与对照组相比，肉毒素组在1个月（分别为（-2.2±1.0 vs.-1.0±1.6；P=0.003）和3个月（分别为（-2.0±1.0 vs.-0.6±1.6；P=0.003）时的疼痛强度显著降低。

没有与肉毒素注射相关的严重不良事件。

&结论：&

在复杂区域性疼痛综合征患者中，使用A型肉毒素进行腰交感神经节阻滞可使患足温度升高3个月，并可减轻疼痛。

Botulinum Toxin Type A for Lumbar Sympathetic GanglionBlock in Complex Regional Pain Syndrome: A Randomized Trial

Background: The present study was designed totest the hypothesis that botulinum toxin would prolong the duration of a lumbarsympathetic block measured through a sustained increase in skin temperature.The authors performed a randomized, double-blind, controlled trial to investigatethe clinical outcome of botulinum toxin type A for lumbar sympathetic ganglionblock in patients with complex regional pain syndrome.

Methods: Lumbar sympathetic ganglion block wasconducted in patients with lower-extremity complex regional pain syndrome using75 IU of botulinum toxin type A (botulinum toxin group) and local anesthetic(control group). The primary outcome was the change in the relative temperaturedifference on the blocked sole compared with the contralateral sole at 1postoperative month. The secondary outcomes were the 3-month changes inrelative temperature differences, as well as the pain intensity changes.

Results: A total of 48 participants (N = 24/group)were randomly assigned. The change in relative temperature increase was higherin the botulinum toxin group than in the control group (1.0°C ± 1.3 vs. 0.1°C ±0.8, respectively; difference: 0.9°C [95% CI, 0.3 to 1.5]; P = 0.006), whichwas maintained at 3 months (1.1°C ± 0.8 vs. -0.2°C ± 1.2, respectively; P =0.009). Moreover, pain intensity was greatly reduced in the botulinum toxingroup compared with the control group at 1 month (-2.2 ± 1.0 vs. -1.0 ± 1.6,respectively; P = 0.003) and 3 months (-2.0 ± 1.0 vs. -0.6 ± 1.6, respectively;P = 0.003). There were no severe adverse events pertinent to botulinum toxininjection.

Conclusions: In patients with complex regionalpain syndrome, lumbar sympathetic ganglion block using botulinum toxin type Aincreased the temperature of the affected foot for 3 months and also reducedthe pain.