Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Med Sci Monit. 2024 Sep 19;30:e945612. doi: 10.12659/MSM.945612.
BACKGROUND Providing pain relief for patients with neuropathic pain syndrome (NPS) is difficult, as sodium-channel blockers pose serious adverse events (AEs). Intravenous (i.v.) lidocaine infusion responses may identify patients likely to benefit from oral sodium channel blockers. We evaluated i.v. lidocaine responses to predict oral oxcarbazepine (OXC) efficacy in patients with NPS. MATERIAL AND METHODS This prospective cohort study administered one-time 3 mg/kg i.v. lidocaine infusion to patients with NPS. Numeric rating scale (NRS) pain scores and AEs were observed. Next, OXC 150 mg was prescribed; dosages were increased by 150 mg every 3 days until ≥50% pain reduction or the maximum tolerable dose or 1800 mg/day was reached. NRS, rescue drug requirements, and AEs were evaluated by phone at 1, 3, and 5 weeks and clinic visits at 2, 4, and 6 weeks. Depression, Anxiety & Stress Scales 21 (DASS-21), and EuroQol-Five Dimensions-Five Levels (EQ-5D-5L) questionnaires were assessed at baseline and in week 6. RESULTS Of 46 patients, 14 discontinued due to intolerable AEs, and 32 were in the final analysis. Average post-intervention NRS significantly decreased from 6.8±1.7 (baseline) to 3.8±2.0 (lidocaine) and 4.1±2.3 (OXC); P<0.001. Negative and positive predictive values for OXC efficacy were 76.2% (95% CI: 61.6-86.5%) and 54.5% (95% CI: 32-75.4%), respectively. Six weeks after OXC treatment, 20 and 11 patients achieved ≥30% pain reduction and ≥50% pain relief, respectively. EQ-5D-5L (P=0.018) and DASS-21 stress dimension (P<0.001) significantly improved. CONCLUSIONS Negative responses to i.v. lidocaine predicted a lack of oral OXC response. AEs of OXC may have obscured an analgesic effect.
治疗神经病理性疼痛综合征（NPS）患者的疼痛较为困难，因为钠离子通道阻滞剂会产生严重的不良反应（AE）。静脉（iv）利多卡因输注反应可能可以识别出可能从口服钠离子通道阻滞剂中受益的患者。我们评估了 iv 利多卡因的反应，以预测 NPS 患者口服奥卡西平（OXC）的疗效。
本前瞻性队列研究对 NPS 患者单次给予 3mg/kg iv 利多卡因输注。观察数字评定量表（NRS）疼痛评分和 AE。然后，开处方给予奥卡西平 150mg；每 3 天增加 150mg，直至疼痛减轻≥50%或达到最大耐受剂量或 1800mg/天。通过电话在第 1、3 和 5 周以及第 2、4 和 6 周就诊时评估 NRS、急救药物需求和 AE。在基线和第 6 周评估抑郁、焦虑和压力量表 21 项（DASS-21）和欧洲五维健康量表-5 级（EQ-5D-5L）问卷。
在 46 名患者中，14 名因无法耐受 AE 而停药，32 名进入最终分析。干预后平均 NRS 显著从 6.8±1.7（基线）降至 3.8±2.0（利多卡因）和 4.1±2.3（OXC）；P<0.001。OXC 疗效的阴性和阳性预测值分别为 76.2%（95%CI：61.6-86.5%）和 54.5%（95%CI：32-75.4%）。OXC 治疗 6 周后，分别有 20 和 11 名患者疼痛缓解≥30%和≥50%。EQ-5D-5L（P=0.018）和 DASS-21 压力维度（P<0.001）显著改善。
iv 利多卡因的阴性反应预测了口服 OXC 反应的缺乏。OXC 的不良反应可能掩盖了其镇痛作用。
