Brooks Athena, Hornbach Anna, Smith Jade E, Garbaccio Noelle C, Keller Nathan, Lemke Jessica, Foppiani Jose A, Gavlasova Dominika, Lee Theodore C, Buckley Marie-Claire, Choudry Umar, Lin Samuel J
Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Int J Mol Sci. 2025 Mar 10;26(6):2460. doi: 10.3390/ijms26062460.
Postoperative pain is a prevalent problem, often lasting from days to years. To minimize opioid use and associated risks of dependency, Enhanced Recovery After Surgery (ERAS) protocols increasingly incorporate multimodal analgesics. Sodium channel-selective blockers are a promising non-opioid alternative, yet their application in postoperative pain remains underexplored. This systematic review evaluates their efficacy in managing postoperative, neuropathic, and neuralgia-related pain. A systematic review was conducted using controlled keywords across multiple databases to identify studies on sodium channel-selective blockers published up to 2024. Eligible studies included clinical trials, observational studies, case series, and reports involving patients aged 18 or older. Data were extracted on therapeutic outcomes, dosages, complications, and comparisons with other analgesics. Five studies met the inclusion criteria, involving 804 patients, 81.58% of whom were women. One study addressed postoperative pain, while the remaining five focused on neuropathy- and neuralgia-related pain. All studies reported significant pain reduction in at least one treatment group compared with placebo. In the study on postoperative pain, the sodium channel-selective blocker significantly reduced pain scores without requiring opioid analgesia. Across all studies, only two patients needed concomitant opioid therapy, and one discontinued treatment due to adverse effects. Dosages varied, with no reports of severe complications. Comparative analyses showed that sodium channel-selective blockers were as effective, if not superior, to traditional pain medications in reducing pain intensity. Sodium channel-selective blockers demonstrate significant potential in pain management with minimal opioid reliance. While effective for neuropathic pain, further studies are essential to validate their role in acute postoperative settings and refine their use in multimodal analgesia regimens.
术后疼痛是一个普遍存在的问题，通常会持续数天至数年。为了尽量减少阿片类药物的使用及其相关的依赖风险，加速康复外科（ERAS）方案越来越多地采用多模式镇痛药物。钠通道选择性阻滞剂是一种很有前景的非阿片类替代药物，但其在术后疼痛中的应用仍未得到充分探索。本系统评价评估了它们在管理术后疼痛、神经性疼痛和神经痛相关疼痛方面的疗效。通过在多个数据库中使用受控关键词进行系统评价，以确定截至2024年发表的关于钠通道选择性阻滞剂的研究。符合条件的研究包括临床试验、观察性研究、病例系列以及涉及18岁及以上患者的报告。提取了有关治疗结果、剂量、并发症以及与其他镇痛药比较的数据。五项研究符合纳入标准，涉及804名患者，其中81.58%为女性。一项研究涉及术后疼痛，其余五项集中在与神经病变和神经痛相关的疼痛。所有研究均报告，与安慰剂相比，至少有一个治疗组的疼痛显著减轻。在关于术后疼痛的研究中，钠通道选择性阻滞剂显著降低了疼痛评分，且无需阿片类镇痛。在所有研究中，只有两名患者需要同时使用阿片类药物治疗，一名患者因不良反应而停止治疗。剂量各不相同，没有严重并发症的报告。比较分析表明，钠通道选择性阻滞剂在减轻疼痛强度方面与传统止痛药一样有效，甚至可能更有效。钠通道选择性阻滞剂在以最小的阿片类药物依赖进行疼痛管理方面显示出巨大潜力。虽然对神经性疼痛有效，但需要进一步研究来验证它们在急性术后环境中的作用，并完善它们在多模式镇痛方案中的使用。
