Nikolajsen Lone, Finnerup Nanna B, Kramp Steffen, Vimtrup Anne-Sofie, Keller Johnny, Jensen Troels S
Danish Pain Research Center, Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
Anesthesiology. 2006 Nov;105(5):1008-15. doi: 10.1097/00000542-200611000-00023.
Pain after amputation is common but difficult to treat. Therefore, the authors examined whether postoperative treatment with gabapentin could reduce postamputation stump and phantom pain.
Forty-six patients scheduled to undergo lower limb amputation were randomly assigned to receive oral gabapentin or placebo. Treatment was started on the first postoperative day and continued for 30 days. The daily dose of gabapentin or placebo was gradually increased to 2,400 mg/day. The intensity of stump and phantom pain was recorded every day on a numeric rating scale (0-10) during the 30-day treatment period. Five interviews were performed after 7, 14, and 30 days and after 3 and 6 months.
Results from 41 patients were included in the data analysis. The risk of phantom pain (gabapentin vs. placebo) was 55.0% versus 52.6% (risk difference, 2.4%; 95% confidence interval, -28.9 to 33.7%; P = 0.88; 30 days) and 58.8% versus 50.0% (risk difference, 8.8%; 95% confidence interval, -23.3 to 40.9%; P = 0.59; 6 months). The median intensity of phantom pain (gabapentin vs. placebo) was 1.5 (range, 0-9.0) versus 1.2 (range, 0-6.6) (P = 0.60; 30 days) and 1.0 (range, 0-6.0) versus 0.5 (range, 0-5.0) (P = 0.77; 6 months). The median intensity of stump pain was 0.85 (range, 0-8.2) versus 1.0 (range, 0-5.4) (P = 0.68; 30 days) and 0 (range, 0-8.0) versus 0 (range, 0-5.0) (P = 0.58; 6 months).
Gabapentin administered in the first 30 postoperative days after amputation does not reduce the incidence or intensity of postamputation pain.
截肢后疼痛很常见，但难以治疗。因此，作者研究了加巴喷丁术后治疗是否能减轻截肢后残端痛和幻肢痛。
46例计划接受下肢截肢的患者被随机分配接受口服加巴喷丁或安慰剂治疗。治疗于术后第一天开始，持续30天。加巴喷丁或安慰剂的日剂量逐渐增加至2400毫克/天。在30天的治疗期内，每天用数字评分量表（0 - 10）记录残端痛和幻肢痛的强度。在第7、14、30天以及3和6个月后进行了五次访谈。
41例患者的结果纳入数据分析。幻肢痛的风险（加巴喷丁组与安慰剂组）在30天时为55.0%对52.6%（风险差异2.4%；95%置信区间，-28.9%至33.7%；P = 0.88），6个月时为58.8%对50.0%（风险差异8.8%；95%置信区间，-23.3%至40.9%；P = 0.59）。幻肢痛的强度中位数（加巴喷丁组与安慰剂组）在30天时为1.5（范围0 - 9.0）对1.2（范围0 - 6.6）（P = 0.60），6个月时为1.0（范围0 - 6.0）对0.5（范围0 - 5.0）（P = 0.77）。残端痛的强度中位数为0.85（范围0 - 8.2）对1.0（范围0 - 5.4）（P = 0.68；30天），6个月时为0（范围0 - 8.0）对0（范围0 - 5.0）（P = 0.58）。
截肢后前30天给予加巴喷丁并不能降低截肢后疼痛的发生率或强度。
