外用利多卡因治疗带状疱疹后神经痛。
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哈利克W，阿拉姆S，普里N
外用利多卡因治疗带状疱疹后神经痛。
Cochrane Database Syst Rev. 2007 04月18日;(2):CD004846。
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17443559 (PubMed视图］
- 摘要
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背景:带状疱疹后神经痛的病因是周围神经元、背根神经节和脊髓背角损伤，继发于带状疱疹感染(带状疱疹)。带状疱疹后神经痛，周围神经元自发放电，激活阈值降低，对刺激的反应夸张。外用利多卡因可抑制外周痛觉感受器致敏和中枢神经系统过度兴奋，并可能对带状疱疹后神经痛患者有益。目的:探讨外用利多卡因治疗带状疱疹后神经痛的疗效和安全性。必威国际app检索策略:我们检索了Cochrane疼痛、姑息和支持治疗组试验登记册、Cochrane对照试验中央登记册(Central)、MEDLINE、EMBASE和LILACS、SIGLE，以获取会议论文集、引文索引、所有合格试验的参考文献清单、关键教科书和以前的系统综述。我们还写信给所有已确定的试验的作者。选择标准:随机或准随机试验，比较所有年龄的带状疱疹后神经痛患者(急性皮疹发作后带状疱疹部位疼痛持续至少一个月)的所有局部应用利多卡因，包括凝胶和贴片。数据收集和分析:两名综述作者提取数据，第三名作者检查数据。我们从美国食品和药物管理局获得了一些缺失的数据。主要结果:包括182名局部利多卡因治疗参与者和132名对照参与者的三项试验。 Two trials gave data on pain relief, and the remaining study provided data on secondary outcome measures. The largest trial published as an abstract compared topical lidocaine patch to a placebo patch and accounted for 150 of the 314 patients (48%).A meta-analysis combining two of the three studies identified a significant difference between the topical lidocaine and control groups for the primary outcome measure: a mean improvement in pain relief according to a pain relief scale. Topical lidocaine relieved pain better than placebo (P = 0.003). There was a statistical difference between the groups for the secondary outcome measure of mean VAS score reduction (P = 0.03), but this was only for a single small trial. There were a similar number of adverse skin reactions in both treatment and placebo groups. The highest recorded blood lidocaine concentration varied between 59 ng/ml and 431 ng/ml between trials. The latter figure is high and the authors of the study suggest that the sample had been contaminated during the assay procedure. AUTHORS' CONCLUSIONS: There is insufficient evidence to recommend topical lidocaine as a first-line agent in the treatment of postherpetic neuralgia with allodynia. Further research should be undertaken on the efficacy of topical lidocaine for other chronic neuropathic pain disorders, and also to compare different classes of drugs (e.g. topical anaesthetics versus anti-epileptics).
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