Zink Karen A, Mayberry John C, Peck Ellen G, Schreiber Martin A
Division of Trauma, Critical Care, & Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
Am Surg. 2011 Apr;77(4):438-42. doi: 10.1177/000313481107700419.
Rib fracture pain is notoriously difficult to manage. The lidocaine patch is effective in other pain scenarios with an excellent safety profile. This study assesses the efficacy of lidocaine patches for treating rib fracture pain. A prospectively gathered cohort of patients with rib fracture was retrospectively analyzed for use of lidocaine patches. Patients treated with lidocaine patches were matched to control subjects treated without patches. Subjective pain reports and narcotic use before and after patch placement, or equivalent time points for control subjects, were gathered from the chart. All patients underwent long-term follow-up, including a McGill Pain Questionnaire (MPQ). Twenty-nine patients with lidocaine patches (LP) and 29 matched control subjects (C) were analyzed. During the 24 hours before patch placement, pain scores and narcotic use were similar (LP 5.3, C 4.6, P = 0.19 and LP 51, C 32 mg morphine, P = 0.17). In the 24 hours after patch placement, LP patients had a greater decrease in pain scores (LP 1.2, C 0.0, P = 0.01) with no change in narcotic use (LP -8.4, C 0.5-mg change in morphine, P = 0.25). At 60 days, LP patients had a lower MPQ pain score (LP 7.7, C 12.2, P < 0.01), although only one patient was still using a patch. There was no difference in time to return to baseline activity (LP 73, C 105 days, P = 0.16) and no adverse events. Lidocaine patches are a safe, effective adjunct for rib fracture pain. Lidocaine patches resulted in a sustained reduction in pain, outlasting the duration of therapy.
肋骨骨折疼痛 notoriously 难以处理。利多卡因贴剂在其他疼痛情况中有效且安全性良好。本研究评估利多卡因贴剂治疗肋骨骨折疼痛的疗效。对前瞻性收集的肋骨骨折患者队列进行回顾性分析，以了解利多卡因贴剂的使用情况。将使用利多卡因贴剂治疗的患者与未使用贴剂的对照受试者进行匹配。从病历中收集贴剂放置前后或对照受试者的等效时间点的主观疼痛报告和麻醉剂使用情况。所有患者均接受长期随访，包括麦吉尔疼痛问卷（MPQ）。分析了29例使用利多卡因贴剂（LP）的患者和29例匹配的对照受试者（C）。在贴剂放置前的24小时内，疼痛评分和麻醉剂使用情况相似（LP为5.3，C为4.6，P = 0.19；LP为51，C为32毫克吗啡，P = 0.17）。在贴剂放置后的24小时内，LP组患者的疼痛评分下降幅度更大（LP为1.2，C为0.0，P = 0.01），而麻醉剂使用情况无变化（LP为-8.4，C为吗啡变化0.5毫克，P = 0.25）。在60天时，LP组患者的MPQ疼痛评分较低（LP为7.7，C为12.2，P < 0.01），尽管只有一名患者仍在使用贴剂。恢复至基线活动的时间无差异（LP为73天，C为105天，P = 0.16），且无不良事件。利多卡因贴剂是治疗肋骨骨折疼痛的一种安全、有效的辅助手段。利多卡因贴剂可使疼痛持续减轻，持续时间超过治疗期。
