Attal N, Rouaud J, Brasseur L, Chauvin M, Bouhassira D
INSERM E-332, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, AP-HP, and Université Versailles-Saint-Quentin, France.
Neurology. 2004 Jan 27;62(2):218-25. doi: 10.1212/01.wnl.0000103237.62009.77.
To investigate the effects of IV lidocaine on spontaneous and evoked pain (allodynia and hyperalgesia) due to peripheral nerve injury (postherpetic neuralgia or nerve trauma) using quantitative sensory testing.
The authors randomized 22 patients to receive lidocaine 5 mg/kg IV during 30 minutes or placebo in a double-blind crossover design and 16 patients subsequently received mexiletine on an open basis titrated from 400 to 1,000 mg per day (mean 737 mg/day).
Lidocaine induced a significant decrease in ongoing pain for up to 6 hours with a peak effect 60 to 120 minutes postinjection. The drug also decreased mechanical dynamic allodynia and static (punctate) mechanical allodynia/hyperalgesia, but not thermal allodynia and hyperalgesia. The effects of lidocaine and mexiletine on spontaneous pain intensity were significantly higher in patients with concomitant mechanical allodynia in comparison with those without allodynia.
These data indicate modality-specific antihyperalgesic effects of IV lidocaine in patients with peripheral nerve injury. Patients with mechanical allodynia may be good candidates for treatment with local anesthetic-like drugs and possibly with other sodium-channel blockers.
采用定量感觉测试法，研究静脉注射利多卡因对因周围神经损伤（带状疱疹后神经痛或神经创伤）所致的自发痛和诱发性疼痛（痛觉过敏和感觉异常）的影响。
作者采用双盲交叉设计，将22例患者随机分为两组，一组在30分钟内静脉注射5mg/kg利多卡因，另一组注射安慰剂；随后，16例患者接受美西律开放治疗，剂量从每天400mg滴定至1000mg（平均737mg/天）。
利多卡因可使持续疼痛显著减轻，长达6小时，注射后60至120分钟时效果最佳。该药还可减轻机械性动态感觉异常以及静态（点状）机械性感觉异常/痛觉过敏，但对热感觉异常和痛觉过敏无效。与无感觉异常的患者相比，利多卡因和美西律对伴有机械性感觉异常患者的自发痛强度影响显著更高。
这些数据表明，静脉注射利多卡因对周围神经损伤患者具有特定形式的抗痛觉过敏作用。伴有机械性感觉异常的患者可能是使用局部麻醉类药物以及其他钠通道阻滞剂进行治疗的合适人选。
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