Wilms B, Meffert K S, Schultes B
Interdisziplinäres Adipositaszentrum, Kantonsspital St. Gallen, St. Gallen, Schweiz.
Dtsch Med Wochenschr. 2010 Nov;135(46):2290-5. doi: 10.1055/s-0030-1267512. Epub 2010 Nov 9.
Acute pancreatitis is commonly associated with severe abdominal pain, making early pain relief a primary goal of the treatment. This study was undertaken to assess the efficacy of a continuous intravenous (i.v.) infusion of procaine compared with that of a placebo infusion in providing pain relief in patients with acute pancreatitis.
42 patients with acute pancreatitis were prospectively randomized to receive, in a double-blind setting, a continuous i.v. infusion of a 1% solution of procaine (procaine group) or placebo (placebo group, receiving a 0.9% saline solution) on the first three days of treatment in a hospital setting. The maximal infusion rate of the procaine solution was 8 ml/h, i.e. 1.92 g/24 h. The rate and total amount of infused fluid was similar in the placebo group. Additionally buprenorphine (Temgesic, sublingual [s.l.]) were given on demand for additional pain relief.
The gender ratio and the severity of the pancreatitis (APACHE II score, Ranson score) were comparable between the two groups, while the patients of the control group were eight years older (50.1 2.3 vs. 58.4 3.1; p = 0.039). The i.v. infusion of procaine did not reduce the demand for buprenorphine in the procaine group and was similar to that in the placebo group (p=0.88). Furthermore, explorative data analysis revealed that patients of the procaine group had higher bodily discomfort and nausea scores and also tended to feel more pain than the patients of the placebo group.
These data do not indicate a clinically meaningful analgesic effect of i.v. infusion of procaine (maximal amount. 1.92 g/24h) in patients with acute pancreatitis, but suggested that this infusion actually increased the feeling of bodily discomfort and nausea. We thus conclude that a constant i.v. infusion of procaine should no longer be recommended for pain relief in patients with acute pancreatitis anymore.
急性胰腺炎常伴有严重腹痛，因此早期缓解疼痛是治疗的主要目标。本研究旨在评估在急性胰腺炎患者中，持续静脉输注普鲁卡因与输注安慰剂相比，在缓解疼痛方面的疗效。
42例急性胰腺炎患者在医院环境中接受治疗的前三天，被前瞻性地随机分组，在双盲条件下接受持续静脉输注1%普鲁卡因溶液（普鲁卡因组）或安慰剂（安慰剂组，接受0.9%生理盐水溶液）。普鲁卡因溶液的最大输注速率为8毫升/小时，即1.92克/24小时。安慰剂组的输注液体速率和总量与之相似。此外，按需给予丁丙诺啡（替诺捷，舌下含服）以进一步缓解疼痛。
两组之间的性别比例和胰腺炎严重程度（急性生理与慢性健康状况评分系统II评分、兰森评分）具有可比性，而对照组患者年龄大8岁（50.1±2.3岁对58.4±3.1岁；p = 0.039）。静脉输注普鲁卡因并未减少普鲁卡因组对丁丙诺啡的需求，且与安慰剂组相似（p = 0.88）。此外，探索性数据分析显示，普鲁卡因组患者的身体不适和恶心评分更高，且比安慰剂组患者往往感觉更疼痛。
这些数据并未表明静脉输注普鲁卡因（最大量1.92克/24小时）对急性胰腺炎患者具有临床意义上的镇痛效果，反而表明这种输注实际上增加了身体不适和恶心的感觉。因此，我们得出结论，不应再推荐持续静脉输注普鲁卡因用于急性胰腺炎患者的疼痛缓解。
