Department of Plastic Surgery, Carmel, Israel.
J Eur Acad Dermatol Venereol. 2012 Apr;26(4):440-7. doi: 10.1111/j.1468-3083.2011.04092.x. Epub 2011 May 10.
Intralesional cryosurgery effectively treats hypertrophic scars and keloids (HSK), but pain experienced by the patient during treatment can limit the application of cryosurgery.
To characterize the pain response during cryosurgical treatment of HSK, and to evaluate the pain experienced during contact and intralesional cryosurgery that employs a pain-control protocol.
Twenty-nine patients (17 women, 12 men) aged 17 years and older (mean ages 31.9±12.5 and 38.9±18.6 years, respectively, P=0.24), who were treated for a total of 36 HSKs by intralesional (n=20; 22 cryotreatments) or contact (n=9; 14 cryotreatments) cryosurgery were evaluated. The pain-control protocol involved oral pain-relief tablets (Dipyrone) and translesional local anaesthesia with Bupivacaine hydrochloride 0.5%. Pain evaluation according to the Visual Analogue Scale (VAS) (0-10 cm) was compared between the two groups at three time points: during cryosurgery, immediately after it, and 4 h later. Scores ≤3 cm were considered to define the 'zone of analgesic success'. These results were compared with control data (contact cryosurgery without a pain-control protocol; n=56).
Pain in the intralesional group was significantly lower than that in the contact group during and immediately after cryotreatment. During: mean VAS=1.68±2.21 vs. 5.07±4.01 cm; median VAS=0.5 vs. 5.5 cm, respectively; P<0.0001. Immediately after: mean VAS=1.22±1.77 vs. 5.38±3.81 cm; median VAS=0 vs. 6.0 cm, respectively; P=0.001. The control group had more pain during treatment (mean VAS=5.34±2.31, median=6.0) and 4 h later (mean=3.79±2.35, median=4.0) than the intralesional group (P<0.0001 and P=0.988, respectively). The pain level in the control group during the cryotreatment did not differ from that in the contact group (P=0.988). In the intralesional, contact and control groups analgesic success (VAS ≤3 cm) was achieved in 77.3%, 35.7% and 33.9%, respectively, of cases (P=0.002) during cryotreatment, and in 54.5%, 42.9% and 33.9%, respectively, of cases 4 h after treatment (P=0.24).
The pain-control protocol significantly reduced pain severity to tolerable levels (VAS ≤3 cm) during and following intralesional and contact cryosurgery. Intralesional cryosurgery caused the least pain during and immediately after treatment.
瘤内冷冻疗法可有效治疗增生性瘢痕和瘢痕疙瘩（HSK），但患者在治疗过程中所经历的疼痛可能会限制冷冻疗法的应用。
描述 HSK 瘤内冷冻治疗过程中的疼痛反应，并评估采用疼痛控制方案的接触式和瘤内冷冻治疗所引起的疼痛。
对 29 名年龄在 17 岁及以上（平均年龄分别为 31.9±12.5 和 38.9±18.6 岁，P=0.24）的患者进行了总共 36 例 HSK 的瘤内（n=20；22 次冷冻治疗）或接触式（n=9；14 次冷冻治疗）冷冻治疗。疼痛控制方案包括口服镇痛药（双氯芬酸）和经皮利多卡因（盐酸布比卡因 0.5%）局部麻醉。根据视觉模拟评分法（VAS）（0-10 cm）在三个时间点比较两组的疼痛：冷冻治疗过程中、治疗结束后即刻和 4 小时后。VAS 评分≤3 cm 定义为“镇痛成功区”。将这些结果与对照组数据（无疼痛控制方案的接触式冷冻治疗；n=56）进行比较。
与接触组相比，瘤内组在冷冻治疗过程中和治疗结束后即刻的疼痛明显减轻。冷冻治疗过程中：平均 VAS=1.68±2.21 vs. 5.07±4.01 cm；中位数 VAS=0.5 vs. 5.5 cm，P<0.0001。治疗结束后即刻：平均 VAS=1.22±1.77 vs. 5.38±3.81 cm；中位数 VAS=0 vs. 6.0 cm，P=0.001。对照组在治疗过程中（平均 VAS=5.34±2.31，中位数=6.0）和 4 小时后（平均=3.79±2.35，中位数=4.0）的疼痛程度均高于瘤内组（P<0.0001 和 P=0.988）。对照组在冷冻治疗过程中的疼痛程度与接触组无差异（P=0.988）。在瘤内、接触和对照组中，冷冻治疗时（VAS≤3 cm）镇痛成功率分别为 77.3%、35.7%和 33.9%，4 小时后分别为 54.5%、42.9%和 33.9%（P=0.002）。
疼痛控制方案可显著降低瘤内和接触式冷冻治疗过程中和治疗后的疼痛严重程度（VAS≤3 cm）。瘤内冷冻治疗在治疗过程中和治疗后即刻引起的疼痛最小。
