静脉注射利多卡因对乳腺癌手术患者慢性术后疼痛的影响：一项前瞻性、双盲、随机、安慰剂对照临床试验。
Effect of intravenous lidocaine on chronic postoperative pain in patients undergoing breast cancer surgery: a prospective, double-blind, randomized, placebo-controlled clinical trial.
作者信息
Xia Ming, Wei Qingfeng, Zhang Qin, Jiang Hong
机构信息
Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.
出版信息
Ann Transl Med. 2022 Jul;10(14):803. doi: 10.21037/atm-22-3522.
BACKGROUND
Chronic postoperative pain (CPSP) is one of the common complications of breast cancer patients, which can seriously affect the quality of life and long-term prognosis of patients. The purpose of this study was to investigate whether perioperative intravenous lidocaine infusion could reduce the incidence of CPSP in patients with breast cancer.
METHODS
Female patients undergoing radical breast cancer surgery were randomly assigned to the 2% lidocaine group (L) and the control group (S). group L received an intravenous infusion of 1.5 mg/kg lidocaine 10 minutes prior to induction, followed by a continuous infusion of 2 mg/kg/h until the end of surgery. The control group received an equal amount of saline. The primary outcome was the incidence of CPSP at 3 months. Secondary outcomes included VAS pain scores and frequency of remedial analgesia within 24 hours postoperatively; incidence of CPSP at 1 and 6 months; and scores on the Brief Pain Inventory (BPI), Simplified McGill Pain Questionnaire (SF-MPQ), and Neuropathic Pain Score (DN-4) at 1, 3, and 6 months postoperatively.
RESULTS
Eighty-two patients participated in this study. A total of 78 patients completed the 3-month postoperative follow-up (39 in group S and 39 in group L). At 3 months, the incidence of CPSP was significantly lower in the L group than in the S group (33.3% in the S group and 12.8% in the L group, P=0.032). Pain scores at rest and during exercise were significantly lower in the L group than in the S group at different time points (P≤0.001 and P<0.001). The need for remedial analgesia at 24 hours postoperatively also differed significantly between the two groups (P=0.036). At 6 months, the incidence of CPSP was also lower in the L group than in the S group (29.7% in the S group and 10.5% in the L group, P=0.038). The differences in SF-MPQ scores were statistically significant at both 3 and 6 months postoperatively (P=0.022, P=0.037).
CONCLUSIONS
Intravenous infusion of lidocaine reduces the incidence of CPSP in breast cancer patients at 3 and 6 months and is effective in relieving acute postoperative pain.
TRIAL REGISTRATION
Chinese Clinical Trial Registry ChiCTR2100050445.
背景
慢性术后疼痛（CPSP）是乳腺癌患者常见的并发症之一，可严重影响患者的生活质量和长期预后。本研究旨在探讨围手术期静脉输注利多卡因是否能降低乳腺癌患者CPSP的发生率。
方法
将接受乳腺癌根治术的女性患者随机分为2%利多卡因组（L组）和对照组（S组）。L组在诱导前10分钟静脉输注1.5mg/kg利多卡因，随后以2mg/（kg·h）持续输注直至手术结束。对照组输注等量生理盐水。主要结局是3个月时CPSP的发生率。次要结局包括术后24小时内的视觉模拟评分（VAS）疼痛评分和补救性镇痛的频率；1个月和6个月时CPSP的发生率；以及术后1、3和6个月时简明疼痛问卷（BPI）、简化麦吉尔疼痛问卷（SF-MPQ）和神经病理性疼痛评分（DN-4）。
结果
82例患者参与本研究。共有78例患者完成了术后3个月的随访（S组39例，L组39例）。3个月时，L组CPSP的发生率显著低于S组（S组为33.3%，L组为12.8%，P=0.032）。在不同时间点，L组静息和运动时的疼痛评分均显著低于S组（P≤0.001和P<0.001）。两组术后24小时补救性镇痛的需求也有显著差异（P=0.036）。6个月时，L组CPSP的发生率也低于S组（S组为29.7%，L组为10.5%，P=0.038）。术后3个月和6个月时，SF-MPQ评分的差异均有统计学意义（P=0.022，P=0.037）。
结论
静脉输注利多卡因可降低乳腺癌患者3个月和6个月时CPSP的发生率，并有效缓解术后急性疼痛。
试验注册
中国临床试验注册中心ChiCTR2100050445。
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