评价围手术期应用文拉法辛或加巴喷丁对急性和慢性乳腺癌根治术后疼痛的疗效。

Evaluation of efficacy of the perioperative administration of Venlafaxine or gabapentin on acute and chronic postmastectomy pain.

机构信息

Anesthesia, ICU and Pain Relief Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

出版信息

Clin J Pain. 2010 Jun;26(5):381-5. doi: 10.1097/AJP.0b013e3181cb406e.

DOI:10.1097/AJP.0b013e3181cb406e

PMID:20473044

Abstract

OBJECTIVES

Postmastectomy pain syndrome is a neuropathic pain syndrome that is known to develop after breast surgery. Preemptive analgesia has been shown to be efficacious in reducing postoperative pain, and may be effective in reducing the incidence of certain types of neuropathic pain. We investigated the analgesic efficacy of Venlafaxine and gabapentin on acute and chronic pain associated with cancer breast surgery.

PATIENTS AND METHODS

The study was carried out on 150 patients scheduled for either partial or radical mastectomy with axillary dissection. They were randomized in a double-blinded manner to receive, extended release Venlafaxine 37.5 mg/d, gabapentin 300 mg/d, or placebo for 10 days starting the night before operation. Pain scores were recorded at rest and movement (visual analog scale) at 4, 12, and 24 hours on the first day postoperatively, daily from the second to tenth day postoperatively and visual analog scale in addition to pain character 6 months later. Analgesic requirements were compared between the 3 groups.

RESULTS

Pain after movement was reduced by gabapentin from the second to tenth postoperative day and venlafaxine group in the last 3 days but no difference was found between the groups regarding pain during rest. Gabapentin reduced morphine consumed in the first 24 hours postoperatively. The analgesic requirements from the second to tenth days for codeine and paracetamol were reduced in venlafaxine and gabapentin groups compared to the control group. Six months later, the incidence of chronic pain, its intensity, and need for analgesics were reduced in venlafaxine compared to gabapentin and the placebo group. However, burning pain was more frequent in the control groups than in the gabapentin.

CONCLUSION

Venlafaxine 37.5 mg/d extended release or gabapentin 300 mg/d have equipotent effects (except on the first day in venlafaxine group) in reducing analgesic requirements, although gabapentin is more effective in reducing pain after movement. Venlafaxine significantly reduced the incidence of postmastectomy pain syndromes (chronic pain) 6 months in women having breast cancer surgery. Gabapentin had no effect on chronic pain except decreasing incidence of burning pain.

摘要

目的

乳腺癌手术后出现的一种神经病理性疼痛综合征，即乳腺癌术后疼痛综合征(postmastectomy pain syndrome, PMPS)。预先镇痛已被证明能有效减轻术后疼痛，并可能有效减少某些类型的神经病理性疼痛的发生。我们研究了文拉法辛和加巴喷丁对乳腺癌手术相关急性和慢性疼痛的镇痛效果。

患者和方法

本研究纳入 150 例行部分或根治性乳房切除术加腋窝清扫术的患者。他们以双盲方式随机分为 3 组，分别接受文拉法辛持续释放片 37.5 mg/d、加巴喷丁 300 mg/d 或安慰剂治疗 10 天，从手术前一晚开始。术后第 1 天 4、12、24 小时记录静息和运动时的疼痛评分（视觉模拟评分），术后第 2 至第 10 天每天记录，术后 6 个月记录视觉模拟评分和疼痛特征。比较 3 组的镇痛需求。

结果

与安慰剂组相比，加巴喷丁组术后第 2 至第 10 天运动时疼痛减轻，文拉法辛组术后第 3 天运动时疼痛减轻，但两组静息时疼痛无差异。加巴喷丁组术后 24 小时内吗啡消耗量减少。与对照组相比，文拉法辛和加巴喷丁组术后第 2 至第 10 天的可待因和对乙酰氨基酚的镇痛需求减少。术后 6 个月，与加巴喷丁组和安慰剂组相比，文拉法辛组慢性疼痛的发生率、强度和镇痛药需求减少。然而，与加巴喷丁组相比，对照组的灼痛更常见。

结论

文拉法辛 37.5 mg/d 持续释放或加巴喷丁 300 mg/d 在减少镇痛需求方面具有等效作用（文拉法辛组仅在第 1 天除外），尽管加巴喷丁在减轻运动后疼痛方面更有效。文拉法辛能显著降低乳腺癌手术女性术后疼痛综合征（慢性疼痛）的发生率 6 个月。加巴喷丁对慢性疼痛没有影响，除了降低灼痛的发生率。