Nordenskjöld Jesper, Waldén Markus, Kjellin Anders, Franzén Herbert, Atroshi Isam
Hässleholm, Lund, Linköping, and Ängelholm, Sweden.
From the Department of Orthopedics, Hässleholm-Kristianstad Hospitals; the Department of Clinical Sciences-Orthopedics, Lund University; the Department of Medical and Health Sciences, Linköping University; and the Department of Orthopedics Aleris, Ängelholm Hospital.
Plast Reconstr Surg. 2017 Sep;140(3):565-569. doi: 10.1097/PRS.0000000000003583.
Collagenase injection for Dupuytren's contracture is commonly administered without anesthesia. The authors studied the benefit of injecting local anesthesia before collagenase in reducing treatment-related pain. This prospective cohort study included 187 patients (mean age, 69 years; 80 percent men) at two orthopedic departments in Sweden. At one center, 161 consecutive patients scheduled for collagenase injection were assigned to two groups by alternating outpatient clinics; 78 received collagenase without local anesthesia using a modified method (injecting 0.80 mg in multiple spots in the cord) and 83 received local anesthesia injected in the proximal palm before collagenase. At the other center, 26 consecutive patients received collagenase using the standard method (0.58 mg injected in one spot) without local anesthesia. Immediately after the first injection (collagenase or local anesthesia), the patients rated the severity of injection-related pain on a visual analogue scale from 0 (no pain) to 10 (worst pain). Before finger manipulation 1 or 2 days after injection, the patients rated the pain experienced since injection. Mean score ± SD for pain experienced during modified collagenase injection was 4.3 ± 2.5 without local anesthesia and 2.3 ± 1.7 during injection of local anesthesia (before collagenase) (age- and sex-adjusted mean difference, 2.1; 95 percent CI, 1.5 to 2.7; p < 0.001). Mean pain score ± SD during standard collagenase injection without local anesthesia was 4.8 ± 1.8. Mean pain score ± SD during the injection-manipulation interval was 2.9 ± 1.9 in the group without local anesthesia and 2.9 ± 2.3 in the local anesthesia group (p = 0.79). This study shows that local anesthesia significantly reduces the patient's overall pain experience during collagenase treatment for Dupuytren's contracture.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
注射胶原酶治疗掌腱膜挛缩通常在无麻醉的情况下进行。作者研究了在注射胶原酶前注射局部麻醉剂对减轻治疗相关疼痛的益处。这项前瞻性队列研究纳入了瑞典两个骨科部门的187名患者（平均年龄69岁；80%为男性）。在一个中心，161例计划接受胶原酶注射的连续患者通过交替门诊被分为两组；78例采用改良方法（在条索状组织的多个部位注射0.80mg）接受无局部麻醉的胶原酶注射，83例在注射胶原酶前在手掌近端接受局部麻醉注射。在另一个中心，26例连续患者采用标准方法（在一个部位注射0.58mg）接受无局部麻醉的胶原酶注射。首次注射（胶原酶或局部麻醉剂）后立即，患者根据视觉模拟评分法对注射相关疼痛的严重程度进行评分，范围为0（无疼痛）至10（最严重疼痛）。在注射后1或2天进行手指手法操作前，患者对自注射以来经历的疼痛进行评分。改良胶原酶注射过程中无局部麻醉时疼痛的平均评分±标准差为4.3±2.5，注射局部麻醉剂（在胶原酶之前）时为2.3±1.7（年龄和性别调整后的平均差值为2.1；95%置信区间为1.5至2.7；p<0.001）。无局部麻醉的标准胶原酶注射过程中疼痛的平均评分±标准差为4.8±1.8。在注射-手法操作间隔期间，无局部麻醉组的平均疼痛评分±标准差为2.9±1.9，局部麻醉组为2.9±2.3（p=0.79）。这项研究表明，局部麻醉可显著减轻注射胶原酶治疗掌腱膜挛缩过程中患者的总体疼痛体验。
临床问题/证据水平：治疗性，II级。
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