Goldfarb Charles A, Gelberman Richard H, McKeon Kathleen, Chia Ben, Boyer Martin I
Washington University School of Medicine, Department of Orthopaedic Surgery at Barnes Hospital, St. Louis, MO 63110, USA.
J Hand Surg Am. 2007 Dec;32(10):1513-20. doi: 10.1016/j.jhsa.2007.08.002.
To evaluate the timing of improvement after extra-articular steroid injection, the incidence of a postinjection pain flare (a delayed postinjection transient increase in pain), and the role of the injection acidity in the postinjection flare.
One hundred twenty-five patients with trigger finger (88 patients) or de Quervain's tenosynovitis (37 patients) were prospectively randomized in this double-blind study to receive either an injection of steroid, lidocaine, and bupivacaine alone (standard injection, acidic pH) or an injection of steroid, lidocaine, bupivacaine, and bicarbonate (balanced injection, neutral pH). All patients completed a visual analog scale for pain before and immediately after the injection, daily for 7 days, and then again at 6 weeks. A flare reaction was defined as an increase in the visual analog scale score by 2 or more points any time after the injection.
All patients immediately responded to the steroid injection, but pain rebounded to preinjection levels by day 1. In both groups the pain then gradually declined over the course of 7 days. In the balanced group, 23 of the 68 patients had flare reactions. In the standard group, 18 of the 57 patients had flare reactions. The difference between groups was not significant.
Patients respond to extra-articular steroid injections with gradual improvement over the course of the first week. An increase in pain, or flare reaction, in the days following a steroid injection was noted in 33% of patients. A pH-balanced injection did not significantly decrease the risk of a flare reaction.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
评估关节外注射类固醇后症状改善的时间、注射后疼痛 flare（注射后疼痛延迟短暂增加）的发生率以及注射酸度在注射后 flare 中的作用。
在这项双盲研究中，125 例患有扳机指（88 例）或桡骨茎突狭窄性腱鞘炎（37 例）的患者被前瞻性随机分组，分别接受单独注射类固醇、利多卡因和布比卡因（标准注射，酸性 pH）或注射类固醇、利多卡因、布比卡因和碳酸氢盐（平衡注射，中性 pH）。所有患者在注射前和注射后立即完成疼痛视觉模拟量表评分，之后每天进行评分，持续 7 天，然后在 6 周时再次评分。flare 反应定义为注射后任何时间视觉模拟量表评分增加 2 分或更多。
所有患者对类固醇注射立即有反应，但疼痛在第 1 天反弹至注射前水平。两组患者的疼痛随后在 7 天内逐渐下降。在平衡组中，68 例患者中有 23 例出现 flare 反应。在标准组中，57 例患者中有 18 例出现 flare 反应。两组之间的差异不显著。
患者对关节外类固醇注射的反应是在第一周内逐渐改善。33%的患者在类固醇注射后的几天内出现疼痛增加或 flare 反应。pH 平衡注射并未显著降低 flare 反应的风险。
研究类型/证据水平：治疗性 I 级。
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