Parthasarathy S, Sundar Siyam, Mishra Gayatri
Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry, India.
Department of Anaesthesiology, Kovai Medical Centre Hospitals, Coimbatore, Tamil Nadu, India.
Indian J Anaesth. 2019 Apr;63(4):300-303. doi: 10.4103/ija.IJA_6_19.
Myofascial pain syndrome (MPS) is a common cause of chronic musculoskeletal pain, characterised by myofascial trigger points (TPs). TP injection is an established technique for management of MPS. In this study, we analysed the efficacy of myofascial TP injection of lignocaine and the influencing biomechanical factors on MPS.
After obtaining ethical committee approval, we included the first 100 adult patients of MPS with failed physical therapy aged above 18 years, and with TPs in the trapezius, infraspinatus, and/or the levator scapulae muscles and Visual analog scale (VAS) >4. TP injection of 2% (2 ml) lignocaine was performed. Visual analogue scale (VAS) scores were recorded immediately and after 1 month. Number of repeat TP injections and use of oral analgesic in one month was noted. Results were analysed with the analysis of variance test.
The mean VAS reduced significantly both immediately and 1 month after therapeutic injections (8.57 ± 0.77, 2.67 ± 1.43 and 2.82 ± 1.4, respectively, < 0.01). Keeping the palm below the head during sleep was the major contributing factor for myofascial TP, followed by slanting the neck to use mobile phones. Repeat TP injection was used in 4% of cases.
TP injection of 2 ml of 2% lignocaine along with correction of predisposing biomechanical factors provided significant pain relief for MPS in patients with failed physical therapy without any side effects.
肌筋膜疼痛综合征(MPS)是慢性肌肉骨骼疼痛的常见原因,以肌筋膜触发点(TPs)为特征。TP注射是治疗MPS的一种既定技术。在本研究中,我们分析了利多卡因肌筋膜TP注射的疗效以及影响MPS的生物力学因素。
获得伦理委员会批准后,我们纳入了前100例年龄在18岁以上、物理治疗无效、斜方肌、冈下肌和/或肩胛提肌有TPs且视觉模拟评分(VAS)>4的成年MPS患者。进行了2%(2ml)利多卡因的TP注射。立即和1个月后记录视觉模拟量表(VAS)评分。记录1个月内重复TP注射的次数和口服镇痛药的使用情况。结果采用方差分析进行分析。
治疗性注射后立即和1个月时,平均VAS均显著降低(分别为8.57±0.77、2.67±1.43和2.82±1.4,P<0.01)。睡眠时将手掌置于头部下方是肌筋膜TP的主要促成因素,其次是倾斜颈部使用手机。4%的病例使用了重复TP注射。
对于物理治疗无效的MPS患者,注射2ml 2%利多卡因并纠正易患生物力学因素可显著缓解疼痛,且无任何副作用。