Tremont-Lukats Ivo W, Challapalli Vidya, McNicol Ewan D, Lau Joseph, Carr Daniel B
*Department of Neurology, Medical University of South Carolina, Charleston, SC; †Department of Anesthesiology and Critical Care, University of Chicago Hospitals, Chicago, IL; ‡Department of Anesthesiology, and §Institute for Clinical Research and Health Policy Studies Tufts-New England Medical Center, Boston, MA.
Anesth Analg. 2005 Dec;101(6):1738-1749. doi: 10.1213/01.ANE.0000186348.86792.38.
We reviewed randomized controlled trials to determine the efficacy and safety of systemically administered local anesthetics compared with placebo or active drugs. Of 41 retrieved studies, 27 trials of diverse quality were included in the systematic review. Ten lidocaine and nine mexiletine trials had data suitable for meta-analysis (n = 706 patients total). Lidocaine (most commonly 5 mg/kg IV over 30-60 min) and mexiletine (median dose, 600 mg daily) were superior to placebo (weighted mean difference on a 0-100 mm pain intensity visual analog scale = -10.60; 95% confidence interval: -14.52 to -6.68; P < 0.00001) and equal to morphine, gabapentin, amitriptyline, and amantadine (weighted mean difference = -0.60; 95% confidence interval: -6.96 to 5.75) for neuropathic pain. The therapeutic benefit was more consistent for peripheral pain (trauma, diabetes) and central pain. The most common adverse effects of lidocaine and mexiletine were drowsiness, fatigue, nausea, and dizziness. The adverse event rate for systemically administered local anesthetics was more than for placebo but equivalent to morphine, amitriptyline, or gabapentin (odds ratio: 1.23; 95% confidence interval: 0.22 to 6.90). Lidocaine and mexiletine produced no major adverse events in controlled clinical trials, were superior to placebo to relieve neuropathic pain, and were as effective as other analgesics used for this condition.
我们回顾了随机对照试验，以确定全身给药的局部麻醉药与安慰剂或活性药物相比的疗效和安全性。在检索到的41项研究中，27项质量各异的试验被纳入系统评价。10项利多卡因试验和9项美西律试验有适合进行荟萃分析的数据（总共706例患者）。利多卡因（最常见的是在30 - 60分钟内静脉注射5mg/kg）和美西律（中位剂量，每日600mg）在治疗神经性疼痛方面优于安慰剂（在0 - 100mm疼痛强度视觉模拟量表上的加权平均差 = -10.60；95%置信区间：-14.52至-6.68；P < 0.00001），且与吗啡、加巴喷丁、阿米替林和金刚烷胺相当（加权平均差 = -0.60；95%置信区间：-6.96至5.75）。对于外周性疼痛（创伤、糖尿病）和中枢性疼痛，治疗益处更为一致。利多卡因和美西律最常见的不良反应是嗜睡、疲劳、恶心和头晕。全身给药的局部麻醉药的不良事件发生率高于安慰剂，但与吗啡、阿米替林或加巴喷丁相当（比值比：1.23；95%置信区间：0.22至6.90）。在对照临床试验中，利多卡因和美西律未产生重大不良事件，在缓解神经性疼痛方面优于安慰剂，并且与用于该病症的其他镇痛药效果相同。
