1 Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation, University of Technology Sydney, Ultimo, Australia.
2 Concord Centre for Palliative Care, Concord Repatriation General Hospital, Sydney, Australia.
J Palliat Med. 2019 Mar;22(3):326-334. doi: 10.1089/jpm.2018.0257. Epub 2019 Jan 7.
Internationally, use of lidocaine infusions to treat cancer pain varies by center. Existing systematic reviews do not adequately inform use of lidocaine in cancer pain.
To assess the effects of systemic sodium channel blockers on cancer pain in adults, review the dose protocols for administration, and assess toxicity.
Databases CENTRAL, MEDLINE, Embase, LILACS, CareSearch, and OpenGrey were searched from inception to 2016. Conference abstracts and reference lists were handsearched, and the lead investigators of included trials and Australian manufacturers were contacted. Included studies were randomized controlled trials evaluating one or more of lidocaine via intravenous or subcutaneous route, or mexiletine, flecainide, or tocainide via oral route; delivered at a site distant to the pain locus. The methodological quality of studies was assessed using the "risk of bias" domain-based evaluation by Jadad. Protocol is available on PROSPERO:CRD42016047092.
One positive (n = 50) and three negative (n = 10 each) crossover trials evaluated lidocaine versus placebo, and one trial (n = 16) compared lidocaine with dexmedetomidine. Meta-analysis of pooled data in 60 patients demonstrated a significant benefit of lidocaine infusion of 4-5 mg/kg over 30-80 minutes compared with placebo for >50% reduction in cancer pain. Secondary outcomes did not show a significant difference.
Based on the current available evidence, lidocaine infusion could be considered in refractory cancer pain where agents with level 1 evidence are ineffective. Further research is necessary to understand the protocol and population in which lidocaine may improve cancer pain and capitalize on the promising opportunities identified.
国际上，利多卡因输注在癌症疼痛治疗中的应用因中心而异。现有的系统评价并不能充分说明利多卡因在癌症疼痛中的应用。
评估系统钠离子通道阻滞剂治疗成人癌症疼痛的效果，综述其给药剂量方案，并评估其毒性。
从建库起至 2016 年，对 CENTRAL、MEDLINE、Embase、LILACS、CareSearch 和 OpenGrey 数据库进行检索。手工检索会议摘要和参考文献，并联系纳入试验的主要研究者和澳大利亚制造商。纳入研究为随机对照试验，评估利多卡因经静脉或皮下途径，或经口途径给予美西律、氟卡尼或甲苯噻嗪；给药部位远离疼痛部位。采用 Jadad 的基于“风险偏倚”领域的评价方法评估研究的方法学质量。方案可在 PROSPERO：CRD42016047092 上获得。
一项阳性（n=50）和三项阴性（n=10 各）交叉试验评估了利多卡因与安慰剂，一项试验（n=16）比较了利多卡因与右美托咪定。60 例患者的汇总数据的荟萃分析显示，与安慰剂相比，4-5mg/kg 的利多卡因输注 30-80 分钟可显著减轻超过 50%的癌症疼痛。次要结局无显著差异。
根据目前的证据，对于无效的 1 级证据药物的难治性癌症疼痛，可以考虑利多卡因输注。需要进一步研究以了解利多卡因可能改善癌症疼痛的方案和人群，并利用已确定的有前途的机会。
