Motamed Hassan, Maleki Verki Mohammadreza
Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Emerg (Tehran). 2017;5(1):e82. doi: 10.22037/emergency.v5i1.18894. Epub 2017 Oct 23.
Using alpha blockers such as intravenous (IV) lidocaine has been deemed effective in controlling acute pain. Therefore, the current study was designed with the aim of evaluating the efficiency of IV lidocaine in comparison to IV fentanyl in pain management of patients with renal colic in emergency department (ED).
In this double blind clinical trial, 18-65 year old patients that presented to ED with colicky flank pain and met the inclusion criteria of the study were allocated to either lidocaine or fentanyl group using block randomization and compared regarding pain severity 5, 10, 15, and 30 minutes after drug administration.
90 patients with the mean age of 35.75±8.87 years were divided into 2 groups of 45 (90% male). The 2 groups were not significantly different regarding the studied baseline variables. Pain severity was not significantly different between the 2 groups at various times after injection. Treatment failure rate 15 minutes after injection was 44.4% (20 cases) in IV lidocaine and 17.8% (8 cases) in IV fentanyl group (p = 0.006). These rates were 26.6% (12 patients) versus 22.2% 30 minutes after injection (p = 0.624). Absolute risk increase of treatment failure in case of using lidocaine was 26.7 (95% CI: 8.3-44.9) in the 15 minute and 4.4 (95% CI: 13.3-22.2) 30 minutes after injection. Number needed to harm (NNH) in treatment with lidocaine 15 and 30 minutes after injection were 4 (95% CI: 2.2-12.0) and 23, respectively.
Although mean pain severity was not significantly different between IV fentanyl and lidocaine at various times after injection, treatment failure rate was significantly higher in the IV lidocaine group 15 minutes after injection.
使用α受体阻滞剂如静脉注射利多卡因已被认为在控制急性疼痛方面有效。因此，本研究旨在评估静脉注射利多卡因与静脉注射芬太尼相比，在急诊科对肾绞痛患者进行疼痛管理的效果。
在这项双盲临床试验中，将年龄在18至65岁、因绞痛性胁腹痛就诊于急诊科且符合研究纳入标准的患者，采用区组随机化方法分为利多卡因组或芬太尼组，并比较给药后5、10、15和30分钟时的疼痛严重程度。
90例平均年龄为35.75±8.87岁的患者被分为2组，每组45例（90%为男性）。两组在研究的基线变量方面无显著差异。注射后不同时间两组的疼痛严重程度无显著差异。静脉注射利多卡因组注射后15分钟的治疗失败率为44.4%（20例），静脉注射芬太尼组为17.8%（8例）（p = 0.006）。注射后30分钟时，这些比率分别为26.6%（12例患者）和22.2%（p = 0.624）。注射后15分钟使用利多卡因时治疗失败的绝对风险增加为26.7（95%可信区间：8.3 - 44.9），注射后30分钟为4.4（95%可信区间：13.3 - 22.2）。注射后15分钟和30分钟使用利多卡因治疗时的伤害所需人数（NNH）分别为4（95%可信区间：2.2 - 12.0）和23。
尽管静脉注射芬太尼和利多卡因后不同时间的平均疼痛严重程度无显著差异，但静脉注射利多卡因组注射后15分钟的治疗失败率显著更高。
