Huang Ying, Xu Chenjie, Zeng Tao, Li Zhongming, Xia Yanzhi, Tao Gaojian, Zhu Tong, Lu Lijuan, Li Jing, Huang Taiyuan, Huai Hongbo, Ning Benxiang, Ma Chao, Wang Xinxing, Chang Yuhua, Mao Peng, Lin Jian
Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
Department of Anesthesiology and Pain, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Korean J Pain. 2021 Apr 1;34(2):210-216. doi: 10.3344/kjp.2021.34.2.210.
Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN.
Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments.
Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression.
IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.
带状疱疹后神经痛（PHN）是急性带状疱疹最常见的并发症。PHN的治疗仍然是临床疼痛管理面临的一项挑战。尽管抗惊厥药、抗抑郁药和利多卡因贴剂在减轻PHN方面有效，但许多患者仍面临顽固性疼痛障碍。在这项随机对照研究中，我们评估了通过静脉自控镇痛（IV PCA）使用氢吗啡酮是否能有效缓解PHN。
PHN患者被随机分为两组，一组接受口服普瑞巴林加静脉注射生理盐水，另一组接受口服普瑞巴林加额外的静脉PCA氢吗啡酮，为期两周。在治疗结束后1、4和12周评估疗效。
201例患者随访12周。治疗后，氢吗啡酮组患者的数字评分量表（NRS）得分显著低于对照组，两组NRS得分在治疗后4周和12周的差异具有统计学意义。治疗后1周和4周，氢吗啡酮组的爆发性疼痛频率显著低于对照组。治疗后，氢吗啡酮组的睡眠质量与对照组相比有显著改善。氢吗啡酮组最常见的不良反应是头晕和恶心，无明显呼吸抑制。
静脉PCA氢吗啡酮联合口服普瑞巴林能为PHN患者提供更好的疼痛缓解，值得临床应用和推广。
