Attal N, Gaudé V, Brasseur L, Dupuy M, Guirimand F, Parker F, Bouhassira D
Centre d'Evaluation et de Traitement de la douleur, Hôpital Ambroise Paré, Boulogne, Paris, France.
Neurology. 2000 Feb 8;54(3):564-74. doi: 10.1212/wnl.54.3.564.
To investigate the effects of systemic administration of lidocaine on different components of neuropathic central pains by quantitative sensory testing.
The efficacy of systemic lidocaine (5 mg/kg IV over 30 minutes) was evaluated in a double-blind, placebo-controlled, and cross-over fashion, on both spontaneous ongoing pain and evoked pains (allodynia and hyperalgesia) in 16 patients with chronic poststroke (n = 6) or spinal cord injury (n = 10) related pain.
Lidocaine was significantly superior to the placebo (saline) in reducing the intensity of spontaneous ongoing pain for up to 45 minutes after the injection: 10 of 16 patients (62.5%) receiving lidocaine showed a significant reduction in spontaneous pain, whereas only six patients showed this after the placebo. Lidocaine also significantly reduced the intensity of brush-induced allodynia and mechanical hyperalgesia, but was no better than the placebo against thermal allodynia and hyperalgesia. In general, the side effects were moderate and consisted mainly of lightheadedness (44%).
Systemic lidocaine can induce a significant and selective reduction of several components of pain caused by CNS injuries. The observed preferential antihyperalgesic and antiallodynic effects of this drug suggest a selective central action on the mechanisms underlying these evoked pains.
通过定量感觉测试研究全身给予利多卡因对神经性中枢性疼痛不同成分的影响。
采用双盲、安慰剂对照和交叉设计，评估全身给予利多卡因（5mg/kg静脉注射，持续30分钟）对16例慢性中风后（n = 6）或脊髓损伤（n = 10）相关疼痛患者的自发性持续疼痛和诱发性疼痛（异常性疼痛和痛觉过敏）的疗效。
注射后长达45分钟，利多卡因在减轻自发性持续疼痛强度方面显著优于安慰剂（生理盐水）：16例接受利多卡因治疗的患者中有10例（62.5%）自发性疼痛显著减轻，而接受安慰剂治疗后只有6例出现这种情况。利多卡因还显著降低了刷擦诱发的异常性疼痛和机械性痛觉过敏的强度，但在对抗热异常性疼痛和痛觉过敏方面并不比安慰剂更好。总体而言，副作用较轻，主要为头晕（44%）。
全身给予利多卡因可显著且选择性地减轻由中枢神经系统损伤引起的多种疼痛成分。该药物观察到的优先抗痛觉过敏和抗异常性疼痛作用表明其对这些诱发性疼痛潜在机制具有选择性中枢作用。
