远端外围神经阻断在腰部根部疼痛中的有效性:一个随机的安慰剂控制的三重盲研究
Vivek Jha1, Gaurav Kumar Sharma2, Omeshwar Singh3
1Department of Orthopaedics, IQ CITY Medical College and Hospital, Durgapur, West Bengal, India.
Journal of craniovertebral junction & spine
|March 10, 2025
概括
在脚神经周围的布皮瓦卡因注射显著减少了根部疼痛,并改善了腰椎间盘脱落患者的直腿抬起. 这种有针对性的方法通过阻断过敏神经末端的通道来提供有效的疼痛缓解.
科学领域:
- 神经学 神经学
- 疼痛管理 疼痛管理
- 药理学 药理学是指药理学的学科.
背景情况:
- 根性疼痛是由神经根炎引起的,导致远端神经末端的机械敏感化和通道上调.
- 在外围神经末端阻断这些通道可以缓解根性疼痛,这是由于感觉神经元的伪单极性质造成的.
研究的目的:
- 评估bupivacaine在缓解疼痛和改善单侧根性疼痛患者的直腿抬起测试 (SLRT) 的有效性.
- 在注射布皮瓦卡因后30分钟,评估疼痛缓解和功能改善,在脚附近的敏感神经周围注射.
主要方法:
- 一项随机的,安慰剂控制的,三重盲研究,涉及100名患有单一水平腰椎盘脱落和单边根部疼痛的患者.
- 患者在脚附近的三个特定的敏感神经 (外侧神经,深神经,后神经) 周围注射了0.5%的布皮瓦卡因或正常盐水.
- 疼痛数值评分表 (NRS) 和SLRT在注射前和注射后30分钟被测量以比较结果,重点关注患者达到临床重要差异最小值 (MCID) 的比例.
主要成果:
- 布皮瓦卡因组显示了从8.06到3.90 (P < 0.001) 的显著平均NRS降低,其中78%的人实现了MCID. 安慰剂组的变化很小 (7.88到7.66,P = 0.084),只有2%的人达到MCID.
- 在布皮瓦卡因组中,SLRT显著改善 (40.90°至60.90°,P<0.001),其中54%达到MCID. 而安慰剂组没有显著改善 (38.10°至39.10°,P=0.351),只有2%的人获得了MCID.
结论:
- 在柔软的脚神经周围注射布皮瓦卡因是一种有效的治疗单侧根性疼痛,与单层腰椎间盘脱落相关.
- 与安慰剂相比,这种干预措施在30分钟内提供了临床显著的疼痛缓解和改善SLRT.
- 该机制涉及阻断敏感的外围神经末端中的通道,为管理根性疼痛提供了有针对性的方法.
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