Bucaretchi Fábio, Mileti Lucas Nascimento Costa Ribeiro, Ricardi Adriana Safioti Toledo, Borrasca-Fernandes Carla Fernanda, Prado Camila Carbone, De Capitani Eduardo Mello, Hyslop Stephen
Centro de Informação e Assistência Toxicológica de Campinas (CIATox), Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Brazil; Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Brazil.
Centro de Informação e Assistência Toxicológica de Campinas (CIATox), Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Brazil.
Toxicon. 2023 Apr;226:107083. doi: 10.1016/j.toxicon.2023.107083. Epub 2023 Mar 8.
Phoneutrism (bites by wandering spiders of the genus Phoneutria) frequently results in local pain. We describe a retrospective cohort study of a case series of phoneutrism admitted to our Emergency Department (ED), in which we used the Numeric Pain Rating Scale (NPRS 0-10) to assess the intensity of local pain upon admission, and recorded the analgesic measures used to control this pain. Other criteria for inclusion were: (1) An age ≥8 years, (2) Treatment exclusively at our ED, and (3) Visualization or photographing the spider at the time of the bite and/or bringing the spider for identification. The patients were classified into three groups based on the intensity of pain at admission: group 1 - mild or no pain (NPRS: 0-3), group 2 - moderate pain (NPRS: 4-6), and group 3 - intense or severe pain (NPRS: 7-10). Fifty-two patients fulfilled the inclusion criteria (n = 11, 14 and 27 in groups 1, 2, and 3, respectively), with a median age of 37 years. The median NPRS upon admission was 7 (interquartile range: 5-8). In patients with an NPRS <7 (groups 1 and 2), only dipyrone was used to alleviate the pain, with six cases in group 1 requiring no analgesia. Most of the cases in group 3 (19/27) were treated with a local anesthetic infiltration (2% lidocaine), in association with analgesics given i.v. in 16 cases (dipyrone, 14; tramadol, 2); additional analgesic treatment was required in seven cases, six of which were treated with tramadol i.v. The median time spent in the ED was 18, 58 and 120 min for groups 1, 2 and 3, respectively. These findings show that most cases of envenoming by Phoneturia spp. involved intense local pain (NPRS ≥7), with local anesthetics being used only in these cases, often in association with dipyrone i.v.
游走蛛属蜘蛛叮咬（Phoneutrism）常导致局部疼痛。我们描述了一项对收入我院急诊科（ED）的一系列游走蛛属蜘蛛叮咬病例的回顾性队列研究，我们使用数字疼痛评分量表（NPRS 0 - 10）评估入院时局部疼痛的强度，并记录用于控制该疼痛的镇痛措施。其他纳入标准为：（1）年龄≥8岁，（2）仅在我院急诊科接受治疗，（3）叮咬时对蜘蛛进行可视化或拍照和/或带来蜘蛛进行鉴定。根据入院时疼痛强度将患者分为三组：第1组 - 轻度或无疼痛（NPRS：0 - 3），第2组 - 中度疼痛（NPRS：4 - 6），第3组 - 剧烈或重度疼痛（NPRS：7 - 10）。52例患者符合纳入标准（第1、2、3组分别为n = 11、14和27例），中位年龄为37岁。入院时的中位NPRS为7（四分位间距：5 - 8）。NPRS <7的患者（第1组和第2组）仅使用安乃近来缓解疼痛，第1组中有6例患者无需镇痛。第3组中的大多数病例（19/27）采用局部麻醉浸润（2%利多卡因）治疗，16例联合静脉注射镇痛药（安乃近14例；曲马多2例）；7例需要额外的镇痛治疗，其中6例采用静脉注射曲马多治疗。第1、2、3组在急诊科的中位停留时间分别为18、58和120分钟。这些发现表明，大多数游走蛛属蜘蛛毒液中毒病例涉及剧烈局部疼痛（NPRS≥7），仅在这些病例中使用局部麻醉药，且常联合静脉注射安乃近。
