Systemic alpha-adrenergic blockade with phentolamine: a diagnostic test for sympathetically maintained pain.
Systemic alpha-adrenergic blockade with phentolamine: a diagnostic test for sympathetically maintained pain.
复制标题
用酚妥拉明进行全身性α-肾上腺素能阻滞：交感神经维持性疼痛的诊断测试。
DOI：
10.1097/00000542-199104000-00012
复制
发表时间：
1991
期刊：
影响因子：
8.8
通讯作者：
Campbell,JN
中科院分区：
文献类型：
--
作者：
Raja,SN;Treede,RD;Davis,KD;Campbell,JN
交感神经维持性疼痛（SMP）的诊断通常通过评估局部麻醉剂阻滞支配疼痛身体部位的交感神经节期间的疼痛缓解来确定。为了确定酚妥拉明的全身α-肾上腺素能阻滞是否可用于诊断SMP，我们比较了20例慢性疼痛和痛觉过敏患者的局部麻醉交感神经节阻滞（LASB）和酚妥拉明阻滞（PhB）对疼痛的影响，这些患者被怀疑是交感神经维持的。在不同的日子里，以随机顺序完成这些区块。患者在LASB和PhB之前、期间和之后每5分钟评定一次持续性疼痛和刺激诱发疼痛的强度。患者和评估疼痛水平的研究者对静脉内施用酚妥拉明（总剂量25-35 mg）的时间不知情。LASB和PhB实现的疼痛缓解密切相关（r= 0.84），两种阻滞实现的最大疼痛缓解无显著差异（t= 0.19，P> 0.8）。9例患者的LASB和PhB疼痛和痛觉过敏缓解超过50%，被认为具有SMP的临床意义。我们的结论是，α-肾上腺素能阻断静脉酚妥拉明是一个敏感的替代测试，以确定SMP患者。
The diagnosis of sympathetically maintained pain (SMP) is typically established by assessment of pain relief during local anesthetic blockade of the sympathetic ganglia that innervate the painful body part. To determine if systemic alpha-adrenergic blockade with phentolamine can be used to diagnose SMP, we compared the effects on pain of local anesthetic sympathetic ganglion blocks (LASB) and phentolamine blocks (PhB) in 20 patients with chronic pain and hyperalgesia that were suspected to be sympathetically maintained. The blocks were done in random order on separate days. Patients rated the intensity of ongoing and stimulus-evoked pain every 5 min before, during, and after the LASB and PhB. Patients and the investigator assessing pain levels were blinded to the time of intravenous administration of phentolamine (total dose 25-35 mg). The pain relief achieved by LASB and PhB correlated closely (r= 0.84), and there was no significant difference in the maximum pain relief achieved with the two blocks (t= 0.19, P greater than 0.8). Nine patients experienced a greater than 50% relief of pain and hyperalgesia from both LASB and PhB and were considered to have a clinically significant component of SMP. We conclude that alpha-adrenergic blockade with intravenous phentolamine is a sensitive alternative test to identify patients with SMP.