静脉注射利多卡因治疗带状疱疹后神经痛的镇痛和情绪反应：一项随机、双盲、安慰剂对照研究

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静脉注射利多卡因治疗带状疱疹后神经痛的镇痛和情绪反应：一项随机、双盲、安慰剂对照研究

贵州医科大学     麻醉与心脏电生理课题组

翻译：刘云琴   编辑：潘志军    审核：曹莹

罂 粟 摘 要 

目的：本研究评估静脉注射利多卡因与安慰剂对带状疱疹后神经痛（PHN）患者的镇痛效果和情绪反应

方法:在这项随机、双盲研究中，PHN患者接受5mg/kg利多卡因静脉输注或安慰剂。主要观察指标为视觉模拟量表（VAS）、Von Frey评分和异常疼痛面积测量。此外，采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评定焦虑和抑郁的情绪状态。采用简易健康问卷36 (SF-36)评估生活质量(QOL)。

结果:我们的研究共纳入197例患者，从其中183名患者中收集了符合条件的数据。输注后2周，VAS评分降至最低值（2.74，2.99），但利多卡因组和安慰剂组之间的疼痛评分、机械性疼痛阈值和异常疼痛面积无显著差异。然而，利多卡因组显著减少了镇痛药的使用，有统计学意义，其相对风险为6.2（95%置信区间，2.24至17.16）。利多卡因输注也显著改善了焦虑和抑郁状态，第2周时SAS和SDS的平均变化分别为3.89（95%可信区间为1.43至6.35）和4.3（95%置信区间为0.63至7.98）。此外，SF36健康状况也有所改善，1w时的平均变化为49.81（95%置信区间，28.17至71.46），特别是在活力、身体和情感功能以及心理健康方面。

结论:PHN患者静脉输注5mg/kg利多卡因的镇痛反应与安慰剂相当，但我们的证据支持静脉输注利多卡因显著降低总镇痛药物的消耗量，并改善整体情绪和健康状况的结论。

原始文献来源：

Hui L , Fan L ,  Dan Z , et al. The Analgesic and Emotional Response to Intravenous Lidocaine Infusion in the Treatment of Postherpetic Neuralgia: A Randomized, Double-Blinded, Placebo-Controlled Study[J]. Clinical Journal of Pain, 2018, 34(11):1.

     英文原文  

The Analgesic and Emotional Response to Intravenous Lidocaine Infusion in the Treatment of Postherpetic Neuralgia: A Randomized,Double-Blinded, Placebo-Controlled Study

Abstract

Objectives: This study evaluates the analgesic efficacy and emotional response of intravenous lidocaine infusion compared with placebo in patients with postherpetic neuralgia(PHN).

Methods: In this randomized, double-blinded study, patients with PHN received 5mg/kg intravenous lidocaine infusion or placebo. The primary outcome was pain relief measured by Visual Analogue Scale (VAS), Von Frey and area of allodynia. Moreover, emotional status of anxiety and depression were evaluated by Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Quality of life (QOL) was assessed by Short Form Health Survey 36 (SF-36).

Results: In total, 197 patients were enrolled in our study and eligible data were collected from 183 patients of those. The VAS scores were reduced to a minimum at 2w (2.74, 2.99) after infusion, but no significant difference was found in pain score, mechanical pain threshold and area of allodynia between the lidocaine and placebo groups. However, the lidocaine group was associated with a statistically significant reduction in consumption of analgesics with relative risk of 6.2 (95%CI, 2.24 to 17.16). Lidocaine infusion also significantly improve the anxiety and depression status, the mean change in SAS and SDS were 3.89 (95%CI, 1.43 to 6.35) and 4.3 (95%CI, 0.63 to 7.98) respectively at 2w. Also, improvement was exhibited in SF36 health status, with the mean change of 49.81 (95% CI, 28.17 to 71.46) at 1w, in particular the sections of the vitality, physical and emotional role functioning, and mental health.

Conclusion: The analgesic response of 5mg/kg lidocaine intravenous infusion is comparable to placebo in patients with PHN, but our evidence supports the conclusion that intravenous lidocaine infusion significantly reduces total analgesic consumption, and improves the overall emotional and health status.

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