Victorian Adult Burns Service and School of Public Health and Preventative Medicine, Monash University, The Alfred Hospital, Commercial Rd, Melbourne, Victoria, Australia.
Burns. 2011 Sep;37(6):951-7. doi: 10.1016/j.burns.2011.03.004. Epub 2011 Apr 15.
Pain is a major issue for patients with severe burn. High dose intravenous opioids form the mainstay of procedural burns pain management; however it was suggested that intravenous lidocaine assists with minimising the pain experience. This study aimed to evaluate whether intravenous lidocaine improved analgesic efficacy and decreased opioid consumption during a burn wound care procedure.
A prospective double-blind randomized crossover study compared intravenous lidocaine versus placebo alongside patient controlled analgesia (PCA) in 45 patients with severe burn undergoing wound care procedures (i.e. dressing change±debridement) on two consecutive days. Subjects were randomised to either the intervention or control condition on the first dressing day, and received the alternate condition on the second dressing day. During the intervention condition, subjects received lidocaine of 1.5 mg/kg/body weight followed by two boluses of 0.5 mg/kg at 5-min intervals followed by a continuous infusion. During the control condition, 0.9% sodium chloride was administered at an equivalent volume, dose and rate to that of lidocaine. Primary end points included pain intensity as measured by verbal rating scale (VRS), time to rescue analgesia, opioid requests and consumption and overall anxiety and level of satisfaction.
Changes in the VRS score was significantly lower for lidocaine [difference (95% CI)=0.36 (0.17-0.55)] as compared to placebo. However, there were no significant clinical or statistical differences regarding the effects of lidocaine and placebo on opioid requests and consumption, anxiety or level of satisfaction during the first and second dressing procedures.
In this study, the clinical benefit of intravenous lidocaine for pain relief during burn wound dressing changes in terms of overall pain scores and opioid consumption was unremarkable. Further investigations using different lidocaine regimes for the management of procedural burn pain are warranted.
疼痛是严重烧伤患者的主要问题。大剂量静脉注射阿片类药物是处理烧伤疼痛的主要方法；然而，有人认为静脉注射利多卡因有助于减轻疼痛体验。本研究旨在评估静脉注射利多卡因是否能提高镇痛效果并减少烧伤创面护理过程中的阿片类药物消耗。
一项前瞻性双盲随机交叉研究比较了静脉注射利多卡因与安慰剂联合患者自控镇痛（PCA）在 45 名严重烧伤患者中的效果，这些患者在连续两天内接受创面护理程序（即换药±清创）。受试者在第一次换药日随机分为干预组或对照组，并在第二次换药日接受另一组治疗。在干预组，受试者接受 1.5mg/kg 体重的利多卡因，然后每 5 分钟给予 0.5mg/kg 的两个推注剂量，然后持续输注。在对照组，给予等体积、剂量和速度的 0.9%氯化钠。主要终点包括疼痛强度（通过视觉模拟评分量表[VRS]测量）、需要急救镇痛的时间、阿片类药物的请求和消耗以及整体焦虑和满意度。
与安慰剂相比，利多卡因组的 VRS 评分变化明显较低[差异（95%置信区间）=0.36（0.17-0.55）]。然而，在第一次和第二次换药过程中，利多卡因和安慰剂对阿片类药物请求和消耗、焦虑或满意度的影响在临床或统计学上没有显著差异。
在这项研究中，静脉注射利多卡因在缓解烧伤创面换药过程中的疼痛方面的临床益处（总体疼痛评分和阿片类药物消耗）并不显著。需要进一步研究不同的利多卡因方案用于处理程序性烧伤疼痛。
Zotero 插件