蝶腭神经节阻滞治疗硬膜外穿刺性头痛：随机、盲法、临床试验
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蝶腭神经节阻滞治疗硬膜外穿刺性头痛：随机、盲法、临床试验
翻译：佟睿 编辑：冯玉蓉 审校：曹莹
背景：目前硬膜外穿刺后头痛的治疗方法之一是硬膜外自体血注射(EBP)，这是一种侵入性的治疗方法，可能会导致罕见并严重的并发症。蝶腭神经节阻滞被认为是治疗硬膜外穿刺术后头痛的一种简单、微创的治疗方法。我们的目的是比较经鼻蝶腭神经节阻滞使用局麻药与生理盐水的镇痛效果。
方法：我们进行了一项盲法、随机的临床试验，纳入符合EBP标准的成年患者。受试者接受双侧蝶腭神经节阻滞，注射1ml局麻药(4%利多卡因和0.5%罗哌卡因)或安慰剂(生理盐水)。主要观察结果为阻滞后30分钟直立位头痛，在0～100 mm VAS上测量。
结果：我们分别将40名直立位头痛基线强度中位数为74mm和84mm的患者随机分为局麻药组和安慰剂组。蝶腭神经节阻滞后30min，局麻药组直立位头痛强度中位数为26 mm，安慰剂组为37 mm(估计中位数差值为5 mm；95%CI -14～21；P＝0.53)。在局麻药组，50%患者需要EBP，而安慰剂组的这一比例为45%(P＝0.76)。
结论：与安慰剂相比，加入局麻药的蝶腭神经节阻滞在30min后对疼痛强度的影响无统计学意义。然而，在两组患者中均有一半的患者疼痛减轻，避免EBP，这表明蝶腭神经节阻滞的主要作用并不来源于局麻药。
原始文献来源：Mads S. Jespersen, Pia Jaeger, Karen L. Ægidius, et al. Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial.[J]. Br J Anaesth 2020 Jun; 124 (6): 739-747.
Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial
Abstract
Background: Current treatment of postdural puncture headache includes epidural blood patch (EBP), which is invasive and may result in rare but severe complications. Sphenopalatine ganglion block is suggested as a simple, minimally invasive treatment for postdural puncture headache. We aimed to investigate the analgesic effect of a transnasal sphenopalatine ganglion block with local anaesthetic vs saline.
Methods: We conducted a blinded, randomised clinical trial including adults fulfilling the criteria for EBP. Participants received a sphenopalatine ganglion block bilaterally with 1 ml of either local anaesthetic (lidocaine 4% and ropivacaine 0.5%) or placebo (saline). Primary outcome was pain in upright position 30 min post-block, measured on a 0~100 mm VAS.
Results: We randomised 40 patients with an upright median pain intensity of 74 and 84 mm in the local anaesthetic and placebo groups at baseline, respectively. At 30 min after sphenopalatine ganglion block, the median pain intensity in upright position was 26 mm in the local anaesthetic group vs 37 mm in the placebo group (estimated median difference: 5mm; 95% confidence interval: -14 to 21; P=0.53). In the local anaesthetic group, 50% required an EBP compared with 45% in the placebo group (P=0.76).
Conclusions: Administration of a sphenopalatine ganglion block with local anaesthetic had no statistically significant effect on pain intensity after 30 min compared with placebo. However, pain was reduced and EBP was avoided in half the patients of both groups, which suggests a major effect not necessarily attributable to local anaesthetics.
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