Lakha Shehnaz Fatima, Mailis Angela
Pain and Wellness Centre, 2301 Major Mackenzie Dr. West, Unit #101, Vaughan, ON, L6A 3Z3, Canada.
Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
Pain Ther. 2024 Aug;13(4):971-986. doi: 10.1007/s40122-024-00621-6. Epub 2024 Jun 20.
Sodium pentobarbital (SP), a short- to intermediate-acting barbiturate, has limited information in the existing literature. The objectives of this study are to describe (a) the effect of intravenous (IV) SP infusion on pain and sensory abnormalities, and (b) its utility in the diagnosis and management of patients with chronic pain.
A narrative review of barbiturate applications for chronic pain was followed by a pragmatic study of 176 consecutive patients admitted to an inpatient pain unit (2004-2009). We collected demographic information upon admission, diagnoses retrieved from chart review, and pain ratings and sensory abnormalities at baseline and after blinded infusion of normal saline (NS) followed by SP.
The study group consisted of 83 men and 93 women (mean age 41 ± 11 years); the mean NS dose was 7.8 ± 2.3 (range 2-10 ml), the SP dose was 223.8 ± 88 mg (range 40-420), and the numeric rating scale (NRS) baseline pain score was 6.0 ± 2. The mean reduction in NRS reached both statistical and clinical significance in 150 responders to either NS/SP or SP only. Collectively, we found (a) an extremely high rate of response to IV SP irrespective of the underlying pathology, (b) greater response for pain than for sensory abnormalities (sensory gains or deficits), (c) greater response for sensory gain than for sensory deficit, and (d) greater response for allodynia than for pinprick hyperalgesia. Illustrative case reports are also presented.
IV SP infusion is a diagnostic tool that assists in elucidating pain generators and the nature of sensory abnormalities (central vs. peripheral), with effects similar to those of IV sodium amytal. The test cannot be viewed as a tell-all diagnostic modality and must be used in conjunction with clinical judgment, investigations, and psychological reports.
戊巴比妥钠（SP）是一种短效至中效巴比妥类药物，现有文献中关于它的信息有限。本研究的目的是描述（a）静脉输注SP对疼痛和感觉异常的影响，以及（b）其在慢性疼痛患者诊断和管理中的效用。
在对巴比妥类药物用于慢性疼痛的应用进行叙述性综述之后，对一家住院疼痛科收治的176例连续患者（2004 - 2009年）进行了一项实用性研究。我们收集了入院时的人口统计学信息、从病历审查中获取的诊断结果，以及在盲法输注生理盐水（NS）后再输注SP之前和之后的疼痛评分及感觉异常情况。
研究组包括83名男性和93名女性（平均年龄41±11岁）；NS的平均剂量为7.8±2.3（范围2 - 10毫升），SP的剂量为223.8±88毫克（范围40 - 420），数字评分量表（NRS）基线疼痛评分为6.0±2。在150例对NS/SP或仅对SP有反应的患者中，NRS的平均降低达到了统计学和临床意义。总体而言，我们发现（a）无论潜在病理情况如何，静脉输注SP的反应率极高，（b）对疼痛的反应大于对感觉异常（感觉增强或减退）的反应，（c）对感觉增强的反应大于对感觉减退的反应，以及（d）对异常性疼痛的反应大于对针刺样痛觉过敏的反应。还给出了典型病例报告。
静脉输注SP是一种诊断工具，有助于阐明疼痛产生的原因和感觉异常的性质（中枢性与外周性），其效果与静脉注射异戊巴比妥钠相似。该测试不能被视为一种万能的诊断方式，必须与临床判断、检查及心理报告结合使用。
