Teaching Hospital, Department of Biomechanics, Medicine and Rehabilitation of Members of the Faculty of Medicine of Ribeirão Preto, University of São Paulo, Av Bandeirantes 3900, Ribeirão Preto-São Paulo 14039 900, Brazil.
Br J Cancer. 2013 Feb 5;108(2):259-64. doi: 10.1038/bjc.2012.593. Epub 2013 Jan 15.
This study was designed to evaluate the role of epidural methadone-lidocaine in cancer pain combined or not to epidural dexamethasone.
In all, 72 cancer patients, 32- to 67-year-old were randomized to six groups (n=12) and prospectively studied to examine analgesia and adverse effects for 3 weeks. Patients received single-dose protocol epidural test drugs: Control group (CG) received epidural 40-mg lidocaine diluted to 10-ml volume with saline. Dexamethasone group (DG) 40-mg lidocaine plus 10-mg dexamethasone. The 2.5MetG 2.5-mg epidural methadone with 40-mg lidocaine; the 5MetG, 5-mg epidural methadone plus 40-mg lidocaine, the 7.5MetG, 7.5-mg epidural methadone plus 40-mg lidocaine and finally the 7.5Met-DexG, 7.5-mg methadone with 40-mg lidocaine and 10-mg dexamethasone.
Groups CG, DG and 2.5MetG were similar regarding analgesia and side effects. Patients from 5MetG and 7.5MetG took 3 ± 1 and 5 ± 1 days, respectively, to restart oral morphine. Patients from 7.5MetDG took 14 ± 2 to restart oral morphine (P<0.001). Daily somnolence and appetite improved in the 7.5MetDG during 2-week evaluation (P<0.005). Fatigue improved for both DG and 7.5MetDG during 2-week evaluation (P<0.005). By the third week of evaluation, all patients were similar.
Epidural methadone plus lidocaine resulted in dose-dependent analgesia, further improved by epidural dexamethasone, which also improved fatigue.
本研究旨在评估硬膜外吗啡-利多卡因在癌症疼痛中的作用，是否联合硬膜外地塞米松。
72 例 32-67 岁的癌症患者随机分为 6 组（每组 12 例），前瞻性研究 3 周的镇痛效果和不良反应。患者接受单次硬膜外试验药物：对照组（CG）给予 40mg 利多卡因+10ml 生理盐水。地塞米松组（DG）给予 40mg 利多卡因+10mg 地塞米松。2.5MetG 给予 2.5mg 硬膜外吗啡+40mg 利多卡因；5MetG 给予 5mg 硬膜外吗啡+40mg 利多卡因；7.5MetG 给予 7.5mg 硬膜外吗啡+40mg 利多卡因；7.5Met-DexG 给予 7.5mg 吗啡+40mg 利多卡因+10mg 地塞米松。
CG、DG 和 2.5MetG 组在镇痛和不良反应方面相似。5MetG 和 7.5MetG 组患者分别需要 3±1 天和 5±1 天才能重新开始口服吗啡。7.5Met-DexG 组患者需要 14±2 天才能重新开始口服吗啡（P<0.001）。在 2 周的评估中，7.5Met-DexG 组患者的日间嗜睡和食欲改善（P<0.005）。在 2 周的评估中，DG 和 7.5Met-DexG 组的疲劳均有改善（P<0.005）。到第 3 周评估时，所有患者均相似。
硬膜外吗啡+利多卡因具有剂量依赖性镇痛作用，联合硬膜外地塞米松可进一步改善镇痛效果，并改善疲劳。
