Department of Internal Medicine, Israelitic Hospital, Hamburg, Germany.
Pancreas. 2011 Jul;40(5):673-9. doi: 10.1097/MPA.0b013e318215ad38.
Intravenous local anesthetics may ameliorate pain and clinical course in patients with major abdominal surgery.
To investigate their effects in acute pancreatitis.
Forty-six consecutive patients with acute pancreatitis randomly received intravenous procaine (2 g/24 h) or placebo for 72 hours in a double-blind fashion. Pain severity (visual analog scale, 0-100), on-demand pain medication (metamizole and/or buprenorphine), and the clinical course were monitored every 24 hours.
Data of 44 patients were subjected to intention-to-treat analysis. Although there were no differences between groups before treatment, procaine treatment was associated with a stronger decrease in pain compared with placebo (median visual analog scale decrement, -62 vs -39, P = 0.025). Moreover, there was a greater proportion of patients with adequate (≥ 67%) pain reduction (75% vs 43%, P = 0.018), less use of additional analgesics (P = 0.042), and overall analgesic superiority (P = 0.015). Compared with placebo, the proportion of patients hospitalized after 2 weeks was reduced by 80% after procaine treatment (P = 0.012).
These findings support the hypothesis that systemic administration of local anesthetics might improve pain and accelerate clinical recovery in acute pancreatitis.
静脉局部麻醉药可能改善重大腹部手术后患者的疼痛和临床病程。
研究其在急性胰腺炎中的作用。
46 例连续的急性胰腺炎患者以双盲方式随机接受静脉普鲁卡因（2 g/24 h）或安慰剂治疗 72 小时。疼痛严重程度（视觉模拟评分，0-100）、按需止痛药物（扑热息痛和/或丁丙诺啡）以及临床病程每 24 小时监测一次。
44 例患者的数据进行了意向治疗分析。尽管治疗前两组之间无差异，但与安慰剂相比，普鲁卡因治疗与更强的疼痛减轻相关（中位数视觉模拟评分降低，-62 对-39，P = 0.025）。此外，有更多的患者疼痛减轻达到足够程度（≥67%）（75%对 43%，P = 0.018），需要额外止痛药物的比例更少（P = 0.042），并且总体上止痛效果更好（P = 0.015）。与安慰剂相比，普鲁卡因治疗后 2 周住院的患者比例降低了 80%（P = 0.012）。
这些发现支持这样一种假设，即全身给予局部麻醉药可能改善急性胰腺炎的疼痛并加速临床恢复。
