Computer-controlled lidocaine infusion for the evaluation of neuropathic pain after peripheral nerve injury
Computer-controlled lidocaine infusion for the evaluation of neuropathic pain after peripheral nerve injury
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DOI：
10.1016/0304-3959(96)02980-6
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发表时间：
1996-07-01
期刊：
影响因子：
7.4
通讯作者：
Yaksh, TL
中科院分区：
文献类型：
--
作者：
Wallace, MS;Dyck, JB;Yaksh, TL
背景：据报道，全身利多卡因可有效治疗多种神经病理性疼痛综合征。很少有报道将血浆利多卡因浓度与镇痛联系起来，而且现有的研究因血浆利多卡因浓度不稳定而变得复杂。我们使用计算机控制的输液泵(CCIP)来靶向和维持稳定的血浆利多卡因浓度，并研究静脉注射利多卡因对周围神经损伤疼痛患者的(1)疼痛评分、(2)电流感觉阈值、(3)副作用和(4)疼痛分布的影响。方法：本研究采用随机、双盲、安慰剂对照设计。11名周围神经损伤后出现神经病理性疼痛的患者在不同的研究阶段接受了利多卡因和生理盐水的输注。研究会议的顺序是随机的，彼此相隔一周。CCIP被编程为以0.5、1、1.5、2和2.5微克/毫升的血浆利多卡因浓度为目标，每个浓度保持10分钟。评估疼痛区域的疼痛评分和疼痛分布，并使用皮肤感知阈值神经计(Neuroeter CPT，Neurotron，巴尔的摩，MD)测量无名指的电流感知阈值(CPT)。每隔一段时间记录副作用。分别于每次增加输液后4min和9min测定血浆利多卡因浓度，并与观察效果进行相关分析。结果：生理盐水输注无效。然而，使用利多卡因后，疼痛评分从1.5微克/毫升开始出现显著的血浆浓度依赖性下降。这种效应通常与疼痛所涉及的感受野的大小减小相对应。对于电刺激，在所考察的最高浓度下，2000赫兹刺激对皮肤感觉没有显著影响；但在250赫兹(开始于1.5微克/毫升)和5赫兹(开始于1.0微克/毫升)刺激时，阈值显著增加。没有严重的副作用。总体而言，54.5%的患者报告头晕(平均血浆利多卡因浓度：1.5mU/ml)，1例患者报告恶心(2.3mU/ml)。讨论：计算机控制的静脉注射利多卡因可产生相对稳定的血药浓度，从而可以更彻底地评估血药浓度和患者反应之间的关系。这种静脉注射利多卡因的给药方法可能被证明是一种有价值的临床和研究工具。
Background: Systemic lidocaine has been reported to be effective in treating several neuropathic pain syndromes. Few reports relate plasma lidocaine concentration to analgesia and the available studies have been complicated by labile plasma lidocaine concentrations. We used a computer-controlled infusion pump (CCIP) to target and maintain stable plasma lidocaine concentrations and study the effect of intravenous lidocaine on (1) pain scores, (2) current perception thresholds, (3) side effects, and (4) pain distribution in patients suffering from peripheral nerve injury pain. Methods: This study used a randomized double-blind placebo-controlled design. Eleven patients suffering from neuropathic pain after peripheral nerve injury received both a lidocaine and saline infusion in separate study sessions. The order of the study sessions was randomized and separated from each other by 1 week. The CCIP was programmed to target plasma lidocaine concentrations of 0.5, 1, 1.5, 2, and 2.5 mu g/ml, each held for 10 min. Pain scores and pain distribution were assessed in the painful area, and electrical current perception thresholds (CPT) of the ring finger were measured using a cutaneous perception threshold neurometer (Neurometer CPT, Neurotron, Baltimore, MD). Side effects were recorded at fixed intervals. Plasma lidocaine concentrations were measured at 4 and 9 min after each step increase in infusion and correlated with the observed effects. Results: Saline infusion had no effect. However, with lidocaine there was a significant plasma concentration-dependent decrease in pain scores starting at 1.5 mu g/ml. This effect typically corresponded with a decrease in the size of the receptive field to which the pain was referred. For the electrical stimulus, there was no significant effect on cutaneous perception at 2000-Hz stimulation at the highest concentration examined; however, there was a significant increase in thresholds at 250-Hz (starting at 1.5 mu g/ml) and 5-Hz (starting at 1.0 mu g/ml) stimulation. There were no serious side effects. In all, 54.5% of patients reported lightheadedness (average plasma lidocaine concentration: 1.5 mu g/ml) and one patient reported nausea (2.3 mu g/ml). Discussion: The computer-controlled delivery of intravenous lidocaine results in relatively stable plasma concentrations which allows a more thorough evaluation of the relationship between plasma concentration and patient response. This administration methodology for intravenous lidocaine may prove to be a valuable clinical and research tool.