局部麻醉用于减轻静脉曲张腔内激光消融围手术期疼痛的疗效：一项双盲随机对照试验
Efficacy of topical local anaesthesia to reduce perioperative pain for endovenous laser ablation of varicose veins: a double-blind randomized controlled trial.
作者信息
Saha Sunita, Tiwari Alok, Hunns Charlotte, Refson Jonathan, Abidia Ahmed
机构信息
Princess Alexandra Hospital, Hamstel Road, Harlow, Essex CM20 1QX, UK
Queen Elizabeth Hospital, Birmingham, UK.
出版信息
Ther Adv Cardiovasc Dis. 2016 Aug;10(4):251-5. doi: 10.1177/1753944716644140. Epub 2016 Apr 19.
OBJECTIVES
Tumescent local anaesthesia via multiple injections in the perivenous space leads to intraoperative and postoperative pain during endovenous laser ablation (EVLA). We considered whether the application of topical local anaesthesia reduces pain caused by these injections.
METHODS
Eligible patients undergoing local anaesthetic EVLA were recruited and randomized to either application of topical local anaesthesia or water-based gel (placebo) to the inner thigh over the marked great saphenous vein. Varicose vein severity was classified using the American venous forum clinical etiological anatomical pathological (CEAP) classification score for chronic venous disorders and the Aberdeen varicose vein questionnaire (AVVQ) score. Visual analogue pain scores attributable to the varicose veins or tumescent injections were recorded before the procedure, immediately postprocedure and prior to discharge. Secondary outcome measures were extra analgesia requirement during or immediately postoperatively. Analysis was performed using the unpaired Student's t test and Wilcoxon signed-rank test.
RESULTS
A total of 52 patients underwent the procedure. Eight patients were excluded from analysis due to failure to complete the procedure or incomplete data. In the remaining 44 patients (24 local anaesthesia, 20 placebo), no statistical difference was noted in age, gender distribution or the severity of varicose veins assessed preoperatively by the clinician (CEAP classification score, median = 2 in both groups) and patient (AVVQ, mean placebo = 21.59, local anaesthesia = 17.53, p = 0.264) between the two groups. There was no statistical difference in pain scores between the placebo and topical local anaesthetic group at baseline (23.0 versus 20.44, p = 0.57), immediately postoperatively (23.35 versus. 19.75, p = 0.44) or predischarge (20.9 versus 13.75, p = 0.68).
CONCLUSIONS
Topical local anaesthesia is of no benefit in EVLA of varicose vein to reduce patient experience of perioperative pain.
目的
在静脉腔内激光消融术（EVLA）期间，通过在静脉周围间隙多次注射肿胀局麻会导致术中和术后疼痛。我们探讨了局部应用局麻是否能减轻这些注射引起的疼痛。
方法
招募符合条件并接受局麻下EVLA的患者，随机分为在内侧大腿标记的大隐静脉上应用局部局麻或水基凝胶（安慰剂）两组。使用美国静脉论坛慢性静脉疾病临床病因解剖病理（CEAP）分类评分和阿伯丁静脉曲张问卷（AVVQ）评分对静脉曲张严重程度进行分类。记录术前、术后即刻和出院前因静脉曲张或肿胀注射导致的视觉模拟疼痛评分。次要结局指标为术中或术后即刻额外镇痛需求。采用非配对学生t检验和Wilcoxon符号秩检验进行分析。
结果
共有52例患者接受了该手术。8例患者因未完成手术或数据不完整被排除在分析之外。在其余44例患者（24例局部局麻，20例安慰剂）中，两组在年龄、性别分布或术前临床医生评估的静脉曲张严重程度（CEAP分类评分，两组中位数均为2）以及患者评估（AVVQ，安慰剂组均值 = 21.59，局部局麻组 = 17.53，p = 0.264）方面均无统计学差异。安慰剂组和局部局麻组在基线时（23.0对20.44，p = 0.57）、术后即刻（23.35对19.75，p = 0.44）或出院前（20.9对13.75，p = 0.68）的疼痛评分均无统计学差异。
结论
局部应用局麻对静脉曲张的EVLA减轻患者围手术期疼痛体验并无益处。
Zotero 插件