Boriani Filippo, Granchi Donatella, Roatti Giulia, Merlini Luciano, Sabattini Tania, Baldini Nicola
Rizzoli Orthopedic Institute, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Rizzoli Orthopedic Institute, Bologna, Italy.
J Hand Surg Am. 2017 Apr;42(4):236-242. doi: 10.1016/j.jhsa.2017.01.011. Epub 2017 Feb 28.
The postoperative course of median nerve decompression in carpal tunnel syndrome may be associated with complications. The aim of this study was to explore the possible effects of alpha-lipoic acid (ALA) in the postoperative period after surgical decompression of the median nerve at the wrist.
We conducted a double-blind prospective, randomized, controlled trial. A total of 64 patients with proven carpal tunnel syndrome were enrolled and randomly assigned into 1 of 2 groups: group A (n = 32) patients had surgical decompression of the median nerve followed by ALA for 40 days, and group P (n = 32) patients had surgical decompression followed by placebo. The primary end point of the study was a comprehensive indicator of sensory and motor nerve conduction velocity (electrophysiology score) at 3 months after surgery, Other end points were static 2-point discrimination, Boston Carpal Tunnel score, presence or absence of pillar pain, and use of analgesics beyond the second postoperative day.
Alpha-lipoic acid did not improve nerve conduction velocity or Boston Carpal Tunnel score significantly. However, a statistically significant reduction in the postoperative incidence of pillar pain was noted in the ALA group. In addition, static 2-point discrimination improved in both groups.
Postoperative administration of ALA for 40 days after median nerve decompression may result in a lower incidence of pillar pain. This treatment is relatively well tolerated, which may support its value as standard postoperative supplementation after carpal tunnel decompression if further studies on larger samples confirm these preliminary findings.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
腕管综合征正中神经减压术后病程可能伴有并发症。本研究旨在探讨α-硫辛酸（ALA）在腕部正中神经手术减压术后的可能作用。
我们进行了一项双盲前瞻性随机对照试验。共纳入64例确诊为腕管综合征的患者，随机分为两组：A组（n = 32）患者接受正中神经手术减压，术后服用ALA 40天；P组（n = 32）患者接受手术减压，术后服用安慰剂。本研究的主要终点是术后3个月时感觉和运动神经传导速度的综合指标（电生理评分），其他终点包括静态两点辨别觉、波士顿腕管评分、是否存在柱部疼痛以及术后第二天后是否使用镇痛药。
α-硫辛酸未显著改善神经传导速度或波士顿腕管评分。然而，ALA组术后柱部疼痛的发生率有统计学意义的降低。此外，两组的静态两点辨别觉均有所改善。
正中神经减压术后给予ALA 40天可能会降低柱部疼痛的发生率。这种治疗耐受性相对较好，如果对更大样本的进一步研究证实这些初步发现，可能支持其作为腕管减压术后标准术后补充治疗的价值。
研究类型/证据水平：治疗性I级。
