Tanen David A, Shimada Mai, Danish D Chris, Dos Santos Frank, Makela Martin, Riffenburgh Robert H
Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California.
University of Tokyo Medical School, Tokyo, Japan.
J Emerg Med. 2014 Jul;47(1):119-24. doi: 10.1016/j.jemermed.2012.12.014. Epub 2014 Apr 24.
Acute radicular back pain is a frequent complaint of patients presenting to the Emergency Department.
Determine the efficacy of intravenous lidocaine when compared to ketorolac for the treatment of acute radicular low back pain.
Randomized double-blind study of 41 patients aged 18-55 years presenting with acute radicular low back pain. Patients were randomized to receive either 100 mg lidocaine or 30 mg ketorolac intravenously over 2 min. A 100-mm visual analog scale (VAS) was used to assess pain at Time 0 (baseline), and 20, 40, and 60 minutes. Changes in [median] VAS scores were compared over time (within groups) by the signed-rank test and between groups by the rank-sum test. A 5-point Pain Relief Scale (PRS) was administered at the conclusion of the study (60 min) and again at 1 week by telephone follow-up; [median] scores were compared between groups by rank-sum.
Forty-four patients were recruited; 41 completed the study (21 lidocaine, 20 ketorolac). Initial VAS scores were not significantly different between the lidocaine and ketorolac groups (83; 95% confidence interval [CI] 74-98 vs. 79; 95% CI 64-94; p = 0.278). Median VAS scores from baseline to 60 min significantly declined in both groups (lidocaine [8; 95% CI 0-23; p = 0.003]; ketorolac [14; 95% CI 0-28; p = 0.007]), with no significant difference in the degree of reduction between groups (p = 0.835). Rescue medication was required by 67% receiving lidocaine, compared to 50% receiving ketorolac. No significant change in PRS between groups was found at the conclusion or at the follow-up.
Intravenous lidocaine failed to clinically alleviate the pain associated with acute radicular low back pain.
急性根性背痛是急诊科患者的常见主诉。
确定与酮咯酸相比，静脉注射利多卡因治疗急性根性下腰痛的疗效。
对41例年龄在18 - 55岁、患有急性根性下腰痛的患者进行随机双盲研究。患者被随机分为两组，分别在2分钟内静脉注射100毫克利多卡因或30毫克酮咯酸。使用100毫米视觉模拟量表（VAS）在时间0（基线）、20、40和60分钟时评估疼痛程度。通过符号秩检验比较两组内VAS评分随时间的变化，通过秩和检验比较两组间的变化。在研究结束时（60分钟）以及1周后通过电话随访使用5分疼痛缓解量表（PRS）；通过秩和检验比较两组间的[中位数]评分。
招募了44例患者；41例完成研究（21例使用利多卡因，20例使用酮咯酸）。利多卡因组和酮咯酸组的初始VAS评分无显著差异（83；95%置信区间[CI] 74 - 98 vs. 79；95% CI 64 - 94；p = 0.278）。两组从基线到60分钟的VAS中位数评分均显著下降（利多卡因组[8；95% CI 0 - 23；p = 0.003]；酮咯酸组[14；95% CI 0 - 28；p = 0.007]），两组间下降程度无显著差异（p = 0.835）。接受利多卡因治疗的患者中有67%需要使用急救药物，而接受酮咯酸治疗的患者中这一比例为50%。在研究结束时和随访时，两组间的PRS均无显著变化。
静脉注射利多卡因未能在临床上缓解与急性根性下腰痛相关的疼痛。
