Price D D, Long S, Wilsey B, Rafii A
Department of Oral and Maxillofacial Surgery, University of Florida, Gainesville 32610, USA.
Clin J Pain. 1998 Sep;14(3):216-26. doi: 10.1097/00002508-199809000-00008.
Pain-relieving effects of lidocaine/bupivicaine local anesthetic (LA) and saline (S) block of sympathetic ganglia (stellate block, 4 patients; lumbar sympathetic block, 3 patients) were compared in 7 complex regional pain syndrome (CRPS) patients on a double-blind crossover basis to evaluate the diagnostic and therapeutic value of local anesthetic sympathetic blocks.
Patients rated their pain on a visual analog scale before and after blocks and were tested for mechanical allodynia one-half hour after blocks. Thereafter, they rated their pain intensity in diaries four times a day for 7 days. Each patient received two blocks, S and LA, and served as his own control.
Both S and LA injections of sympathetic ganglia produced large reductions in pain intensity in 6 of 7 patients 30 minutes after block. These large reductions were accompanied by the reversal of mechanical allodynia in both S and LA. The mean difference between initial peak reduction in pain intensity produced by saline (68.7%) and active local anesthetic (74.4%) did not approach statistical significance. In striking contrast, the mean duration of pain relief was reliably longer in the case of LA (3 days, 18 hours) as compared with S ( 19.9 hours), a difference that occurred in all 7 patients. In a larger sample of 41 CRPS patients, signs of sympathetic efferent blockade, including Homer' s syndrome or skin surface temperature change, were not predictive of initial peak magnitude of pain relief from sympathetic blockade but were predictive of duration of pain reduction.
The combination of these results provides evidence that duration of pain relief is affected by injection of local anesthetics into sympathetic ganglia. These results indicate that both magnitude and duration of pain reduction should be closely monitored to provide optimal efficacy in procedures that use local anesthetics to treat CRPS.
在7例复杂性区域疼痛综合征（CRPS）患者中，采用双盲交叉试验比较利多卡因/布比卡因局部麻醉药（LA）和生理盐水（S）阻滞交感神经节（星状神经节阻滞4例患者；腰交感神经节阻滞3例患者）的镇痛效果，以评估局部麻醉药交感神经节阻滞的诊断和治疗价值。
患者在阻滞前后采用视觉模拟评分法对疼痛进行评分，并在阻滞后半小时测试机械性异常性疼痛。此后，他们在7天内每天4次在日记中记录疼痛强度。每位患者接受两次阻滞，即S和LA阻滞，并作为自身对照。
7例患者中有6例在交感神经节注射S和LA后30分钟疼痛强度大幅降低。这些大幅降低伴随着S和LA组机械性异常性疼痛的逆转。生理盐水（68.7%）和活性局部麻醉药（74.4%）引起的疼痛强度初始峰值降低之间的平均差异未达到统计学意义。与之形成鲜明对比的是，与S组（19.9小时）相比，LA组的平均镇痛持续时间确实更长（3天18小时），7例患者均出现这种差异。在41例CRPS患者的更大样本中，交感神经传出阻滞的体征，包括霍纳综合征或皮肤表面温度变化，不能预测交感神经阻滞初始疼痛缓解的峰值幅度，但可预测疼痛减轻的持续时间。
这些结果共同表明，将局部麻醉药注射到交感神经节中会影响镇痛持续时间。这些结果表明，在使用局部麻醉药治疗CRPS的过程中，应密切监测疼痛减轻的幅度和持续时间，以实现最佳疗效。
