Rowbotham M C, Davies P S, Fields H L
Department of Neurology, University of California-San Francisco 94143.
Ann Neurol. 1995 Feb;37(2):246-53. doi: 10.1002/ana.410370216.
Postherpetic neuralgia (PHN) following herpes zoster is a common and disabling neuropathic pain syndrome. In a double-blind, three-session study, 5% lidocaine gel or vehicle was applied simultaneously to both the area of pain and to the contralateral mirror-image unaffected skin. In the local session, lidocaine gel was applied to the painful skin area. In the remote session, lidocaine gel was applied to mirror-image skin. In the placebo session, vehicle was applied bilaterally. For cranial PHN, gel was applied without occlusion for 8 hours. For limb or torso PHN, gel was applied under occlusion for 24 hours. The 16 subjects with cranial PHN reported pain relief significantly favoring local drug application at 30 minutes, 2, 4, and 8 hours. The 23 subjects with torso or limb PHN reported significantly lower pain intensity with local drug application at 8 hours and both pain relief and reduced pain intensity at 24 hours. Remote lidocaine application to mirror-image skin was no different from placebo. No systemic adverse effects were reported and blood levels did not exceed 0.6 microgram/ml. Topical application of 5% lidocaine gel relieves PHN pain by a direct drug action on painful skin.
带状疱疹后神经痛（PHN）是一种常见且致残的神经性疼痛综合征。在一项双盲、分三个阶段的研究中，将5%利多卡因凝胶或赋形剂同时应用于疼痛区域和对侧镜像未受影响的皮肤。在局部阶段，将利多卡因凝胶应用于疼痛皮肤区域。在远程阶段，将利多卡因凝胶应用于镜像皮肤。在安慰剂阶段，双侧应用赋形剂。对于颅部PHN，凝胶不封闭应用8小时。对于肢体或躯干PHN，凝胶封闭应用24小时。16例颅部PHN患者报告在30分钟、2小时、4小时和8小时时，局部用药显著更有利于缓解疼痛。23例躯干或肢体PHN患者报告在8小时时局部用药疼痛强度显著降低，在24小时时疼痛缓解且疼痛强度降低。对镜像皮肤进行远程利多卡因应用与安慰剂无差异。未报告有全身不良反应，血药浓度未超过0.6微克/毫升。局部应用5%利多卡因凝胶通过对疼痛皮肤的直接药物作用缓解PHN疼痛。
