The role of peripheral afferents in persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial of ultrasound-guided tender point blockade.
The role of peripheral afferents in persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial of ultrasound-guided tender point blockade.
复制标题
外周传入神经在持续性腹股沟术后疼痛中的作用：超声引导压痛点阻断的随机、双盲、安慰剂对照、交叉试验。
DOI：
10.1093/bja/aew071
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发表时间：
2016
影响因子：
9.8
通讯作者：
Werner,MU
中科院分区：
文献类型：
--
作者：
Wijayasinghe,N;Ringsted,TK;Bischoff,JM;Kehlet,H;Werner,MU
背景严重的持续性腹股沟热后修补术后疼痛(PIPP)是一种衰弱的疾病，发生在2-5%的患者中。PIPP本质上可能是神经性的，但周围神经系统的病变尚未定位。大多数PIPP患者在腹股沟区域的内侧显示压痛点(TP)，在最小压力下触发疼痛。鉴于TPS可能在PIPP的病理生理过程中起一定作用，本研究旨在探讨局麻药TP-阻滞剂的镇痛作用。方法采用随机、双盲、安慰剂对照、交叉试验的方法，对14例PIPP患者和6名健康志愿者进行研究。所有患者均参加了两次治疗，间隔7天，在TP处通过超声引导筋膜平面阻滞注射0.25%布比卡因或生理盐水10毫升。结果布比卡因治疗后疼痛减轻的中位数(95%CI)为63%(44.1~73.6%)，安慰剂为36%(11.6~49.7%；P=0.003)。单用布比卡因后，冷感觉阈值(P=0.009)和压痛阈值(P=0.003)显著升高，阈值以上热痛觉明显降低(P=0.003)。在6名志愿者中，有4名在布比卡因后与安慰剂相比有更高的温度和诱发痛阈值。结论本试验表明，来自TP区的外周传入对于维持PIPP中的自发和诱发疼痛是重要的。临床试验注册NCT02065219。
BackgroundSevere, persistent inguinal postherniorrhaphy pain (PIPP) is a debilitating condition that develops in 2–5% of patients. PIPP may be neuropathic in nature, yet the lesion in the peripheral nervous system has not been located. Most PIPP-patients demonstrate a tender point (TP) in the medial aspect of the inguinal region that triggers pain upon minimal pressure. As TPs may play a role in the pathophysiology of PIPP, the aim of this trial was to investigate the analgesic effects of local anaesthetic TP-blockade.MethodsA randomized, double-blind, placebo-controlled, crossover trial was performed in 14 PIPP-patients and six healthy volunteers. All participated in two sessions, seven days apart, receiving 10 ml of 0.25% bupivacaine or normal saline via an ultrasound-guided fascial plane block at the TP. The TP-area was used for pain assessments (at rest, on movement, with 100 kPa pressure-algometry) and quantitative sensory testing (pressure pain thresholds, thermal detection/pain thresholds, supra-threshold heat perception), before and after the TP-blockade.ResultsThe median (95% CI) reduction in pain was 63% (44.1 to 73.6%) after bupivacaine compared with 36% (11.6 to 49.7%;P=0.003) after placebo. Significant increases in cool detection (P=0.01) and pressure pain thresholds (P=0.009) with decreases in supra-threshold heat pain perception (P=0.003) were seen after bupivacaine only. In four out of six volunteers, increased thermal and evoked-pain thresholds after bupivacaine compared with placebo, was demonstrated.ConclusionsThis trial demonstrates that peripheral afferent input from the TP-area is important for maintenance of spontaneous and evoked pain in PIPP.Clinical trial registrationNCT02065219.