Briggs M, Nelson E A
Division of Nursing, School of Health Care Studies, University of Leeds, 22 Hyde Terrace, University of Leeds, West Yorkshire, UK, LS1.
Cochrane Database Syst Rev. 2003(1):CD001177. doi: 10.1002/14651858.CD001177.
Venous leg ulcers affect up to 1 per cent of people at some time in their life. These ulcers are often painful and some clinicians choose dressings and topical treatments (analgesia/ local anaesthetic) to reduce the pain both during and between dressing changes.
To assess the effectiveness of dressings, local anaesthetics or topical analgesia for pain relief in venous leg ulceration.
Cochrane Wounds Group Register and the Cochrane Collaboration Field in Complementary Medicine were searched in June 2002. Cochrane Pain Palliative and Supportive Care Group and Cochrane Wounds Group strategy were combined and used.
All randomised controlled trials which evaluated local interventions used to relieve venous leg ulcer pain were considered. Pain was defined as either persistent pain or pain at dressing changes or debridement.
Eligibility for inclusion was confirmed by two reviewers who independently assessed the potential trials. Details of eligible studies were summarised using a data extraction sheet which was checked by the second reviewer.
No trials evaluating interventions for persistent pain were identified for the initial review in 1999 nor the update in 2002. Three trials were included in the 1999 review comparing a eutectic mixture of local anaesthetic (EMLA) versus placebo for pain at debridement. In 2002 a further 3 trials were available (6 trials in total with 317 patients). The studies were considered sufficiently similar to pool and meta analysis found a statistically significant reduction in debridement pain scores with EMLA 5% cream. EMLA was associated with a reduction in pain scores (measured on a 100 mm scale) of 20.6 mm (95% Confidence Interval 29.11-12.19). One small trial measured healing as an outcome and found no difference in numbers of ulcers healed at the end of the study.
REVIEWER'S CONCLUSIONS: EMLA provides effective pain relief for venous leg ulcer debridement however, the effect of the product on ulcer healing is unknown. Research is required to determine the impact of debridement and of EMLA on ulcer healing. There were no trials addressing the treatment of persistent pain (between and at dressing changes) and further research is warranted.
腿部静脉溃疡在人们一生中的某些时候影响着多达1%的人群。这些溃疡常常疼痛，一些临床医生会选择敷料和局部治疗（镇痛/局部麻醉）来减轻换药期间及换药间隔的疼痛。
评估敷料、局部麻醉剂或局部镇痛在缓解腿部静脉溃疡疼痛方面的有效性。
2002年6月检索了Cochrane伤口组登记册和补充医学领域的Cochrane协作网。将Cochrane疼痛、姑息与支持治疗组及Cochrane伤口组的检索策略合并使用。
纳入所有评估用于缓解腿部静脉溃疡疼痛的局部干预措施的随机对照试验。疼痛定义为持续性疼痛或换药或清创时的疼痛。
两名评审员独立评估潜在试验以确认纳入资格。使用数据提取表总结符合条件研究的详细信息，该表由第二名评审员检查。
1999年的初次综述及2002年的更新版均未找到评估缓解持续性疼痛干预措施的试验。1999年的综述纳入了3项试验，比较了局部麻醉剂的共熔混合物（EMLA）与安慰剂在清创时的止痛效果。2002年又有3项试验可用（总共6项试验，317名患者）。这些研究被认为足够相似，可以进行汇总分析，结果发现5%的EMLA乳膏在清创疼痛评分上有统计学显著降低。EMLA使疼痛评分（在100毫米量表上测量）降低了20.6毫米（95%置信区间29.11 - 12.19）。一项小型试验将愈合作为一项结果进行测量，发现在研究结束时溃疡愈合数量没有差异。
EMLA可为腿部静脉溃疡清创提供有效的疼痛缓解，然而，该产品对溃疡愈合的影响尚不清楚。需要开展研究以确定清创及EMLA对溃疡愈合的影响。没有试验涉及持续性疼痛（换药期间及换药时）的治疗，因此有必要进行进一步研究。
