静脉注射利多卡因治疗胰腺导管腺癌和慢性胰腺炎患者的难治性疼痛：一项多中心前瞻性非随机试点研究。

IF 3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinical and Translational Gastroenterology Pub Date : 2024-09-01 DOI:10.14309/ctg.0000000000000760

Simone Augustinus, Matthanja Bieze, Charlotte L Van Veldhuisen, Marja A Boermeester, Bert A Bonsing, Stefan A W Bouwense, Marco J Bruno, Olivier R Busch, Werner Ten Hoope, Jan-Willem Kallewaard, Henk J van Kranen, Marieke Niesters, Niels C J Schellekens, Monique A H Steegers, Rogier P Voermans, Judith de Vos-Geelen, Johanna W Wilmink, Jan H M Van Zundert, Casper H van Eijck, Marc G Besselink, Markus W Hollmann

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引用次数: 0

摘要

导言：难治性疼痛是胰腺导管腺癌（PDAC）和慢性胰腺炎（CP）患者的主要临床问题。目前迫切需要新的、有效的止痛疗法。静脉注射利多卡因被用于 PDAC 和 CP 患者的临床实践，但尚未对其疗效进行前瞻性研究：多中心前瞻性非随机试验研究纳入了荷兰 5 个中心的中度或重度疼痛（数字评分量表≥ 4）的 PDAC 或 CP 患者。静脉注射利多卡因 1.5 毫克/千克，然后以 1.5 毫克/千克/小时的速度持续输注。剂量每15分钟增加一次，直至治疗反应（最大剂量为2毫克/千克/小时），连续输注2小时。主要结果是输液前和输液后第一天疼痛严重程度的平均差异（简明疼痛量表 [BPI] 评分 1-10）。BPI下降≥1.3分被认为与临床相关：共纳入 30 名患者，其中 PDAC 患者 19 名（占 63%），CP 患者 11 名（占 37%）。第 1 天，PDAC 患者的 BPI 平均值相差 1.1（标度±1.3）分，CP 患者的 BPI 平均值相差 0.5（标度±1.7）分。29 例患者中有 9 例（31%）在第 1 天出现了临床相关的 BPI 下降，这种反应持续了长达 1 个月。无严重并发症报告，仅有 3 例轻微并发症（眩晕、恶心和口腔刺痛）。利多卡因治疗不会影响患者的生活质量：讨论：静脉注射利多卡因治疗疼痛的 PDAC 和 CP 患者并未显示出临床相关的总体减痛效果。然而，这项试点研究表明，这种治疗方法在这一患者群体中是可行的，并对三分之一的患者产生了积极的影响，这种影响可持续一个月，且只有轻微的副作用。为了证明或排除静脉注射利多卡因的疗效，这项研究应在样本量更大、异质性更小的患者群体中进行。

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Intravenous Lidocaine for Refractory Pain in Patients With Pancreatic Ductal Adenocarcinoma and Chronic Pancreatitis: A Multicenter Prospective Nonrandomized Pilot Study.

Introduction: Refractory pain is a major clinical problem in patients with pancreatic ductal adenocarcinoma (PDAC) and chronic pancreatitis (CP). New, effective therapies to reduce pain are urgently needed. Intravenous lidocaine is used in clinical practice in patients with PDAC and CP, but its efficacy has not been studied prospectively.

Methods: Multicenter prospective nonrandomized pilot study included patients with moderate or severe pain (Numeric Rating Scale ≥ 4) associated with PDAC or CP in 5 Dutch centers. An intravenous lidocaine bolus of 1.5 mg/kg was followed by continuous infusion at 1.5 mg/kg/hr. The dose was raised every 15 minutes until treatment response (up to a maximum 2 mg/kg/hr) and consecutively administered for 2 hours. Primary outcome was the mean difference in pain severity, preinfusion, and the first day after (Brief Pain Inventory [BPI] scale 1-10). A BPI decrease ≥1.3 points was considered clinically relevant.

Results: Overall, 30 patients were included, 19 with PDAC (63%) and 11 with CP (37%). The mean difference in BPI at day 1 was 1.1 (SD ± 1.3) points for patients with PDAC and 0.5 (SD ± 1.7) for patients with CP. A clinically relevant decrease in BPI on day 1 was reported in 9 of 29 patients (31%), and this response lasted up to 1 month. No serious complications were reported, and only 3 minor complications (vertigo, nausea, and tingling of mouth). Treatment with lidocaine did not impact quality of life.

Discussion: Intravenous lidocaine in patients with painful PDAC and CP did not show an overall clinically relevant reduction of pain. However, this pilot study shows that the treatment is feasible in this patient group and had a positive effect in a third of patients which lasted up to a month with only minor side effects. To prove or exclude the efficacy of intravenous lidocaine, the study should be performed in a study with a greater sample size and less heterogeneous patient group.

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来源期刊

Clinical and Translational Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.00

自引率

0.00%

发文量

114

审稿时长

16 weeks

期刊介绍： Clinical and Translational Gastroenterology (CTG), published on behalf of the American College of Gastroenterology (ACG), is a peer-reviewed open access online journal dedicated to innovative clinical work in the field of gastroenterology and hepatology. CTG hopes to fulfill an unmet need for clinicians and scientists by welcoming novel cohort studies, early-phase clinical trials, qualitative and quantitative epidemiologic research, hypothesis-generating research, studies of novel mechanisms and methodologies including public health interventions, and integration of approaches across organs and disciplines. CTG also welcomes hypothesis-generating small studies, methods papers, and translational research with clear applications to human physiology or disease. Colon and small bowel Endoscopy and novel diagnostics Esophagus Functional GI disorders Immunology of the GI tract Microbiology of the GI tract Inflammatory bowel disease Pancreas and biliary tract Liver Pathology Pediatrics Preventative medicine Nutrition/obesity Stomach.