The Department of Hand Surgery, Plastic Surgery and Burns, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
The Department of Hand Surgery, Plastic Surgery and Burns, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Burns. 2020 Mar;46(2):465-471. doi: 10.1016/j.burns.2019.08.010. Epub 2019 Sep 5.
The pain of a burn mainly results from the inflammatory cascade that is induced by the injured tissue, and is classified as background, breakthrough, procedural and postoperative pain. High doses of opioids are usually needed to treat background pain, so its management includes a combination of types of analgesia to reduce the side effects. Lidocaine given intravenously has been shown in two small, uncontrolled studies to have an appreciable effect on pain after burns.
In this prospective double-blind controlled trial we aimed to examine and quantify the opioid-sparing effect of a continuous infusion of lidocaine for the treatment of background pain during the early period after a burn.
Adult patients injured with burns of >10 total body surface area burned (TBSA%) and treated with a morphine based patient-controlled analgesia device (PCA) were randomised to have either lidocaine infusion starting with a bolus dose (1 mg lidocaine/kg) followed by continuous infusion (180 mg lidocaine/hour) or a placebo infusion, for seven consecutive days. Total daily consumption of opioids (mg) and amount of pain (visual analogue score, VAS) were recorded.
We included 19 patients, 10 of whom were given a lidocaine infusion. There were no differences between groups in VAS, TBSA%, time of enrolment to the study since the initial burn, or duration of hospital stay. The opioid consumption in the lidocaine group declined by roughly 25% during the period of the study.
An intravenous infusion of lidocaine was safe and had an opioid-sparing effect when treating background pain in burns.
烧伤引起的疼痛主要来源于损伤组织引发的炎症级联反应，可分为背景疼痛、突破性疼痛、操作性疼痛和术后疼痛。治疗背景疼痛通常需要大剂量的阿片类药物，因此其治疗包括联合使用多种镇痛方式，以减少副作用。静脉内给予利多卡因已在两项小型非对照研究中显示对烧伤后疼痛有明显作用。
在这项前瞻性双盲对照试验中，我们旨在研究和量化利多卡因持续输注对烧伤后早期背景疼痛的阿片类药物节省作用。
成人烧伤面积＞10%总体表面积（TBSA%），并使用吗啡为基础的患者自控镇痛（PCA）设备治疗的患者，随机分为利多卡因输注组（起始剂量为 1mg 利多卡因/公斤，然后持续输注 180mg 利多卡因/小时）或安慰剂输注组，连续输注 7 天。记录每日总阿片类药物消耗量（mg）和疼痛程度（视觉模拟评分，VAS）。
我们纳入了 19 名患者，其中 10 名接受了利多卡因输注。两组在 VAS、TBSA%、从初始烧伤开始纳入研究的时间以及住院时间方面均无差异。在研究期间，利多卡因组的阿片类药物消耗量下降了约 25%。
静脉内输注利多卡因治疗烧伤的背景疼痛是安全的，且具有阿片类药物节省作用。
