围术期口服普瑞巴林对非小细胞肺癌根治术后慢性疼痛的影响

EFFECTIVENESS OF PERIOPERATIVE ORAL PREGABALIN ON CHRONIC PAIN AFTER RADICAL RESECTION OF NON-SMALL-CELL LUNG CANCER

目的：探讨围术期口服普瑞巴林能否缓解肺癌根治手术患者的手术后神经病理性疼痛。方法：20~65岁全麻下行限期肺癌根治术的非小细胞肺癌患者90例,随机分为三组。最后纳入74人：PG1（n=23）,手术当天术前两小时口服普瑞巴林300 mg,手术第二天开始口服普瑞巴林150 mg bid×5天。PG2组（n=21）,术前两小时口服普瑞巴林300 mg,手术第二天开始口服普瑞巴林75 mg bid×5天;对照组（C组,n=30）,术前两小时口服安慰剂（空胶囊）一粒,手术第二天开始口服安慰剂bid×5天;三个组术后均给予芬太尼静脉自控镇痛（PCIA）。术后第2月、4、6月电话随访患者术后慢性疼痛的程度和疼痛性质。结果：（1）术后第2个月三组间比较：PG1组及PG2组比C组的静止性疼痛以及运动性疼痛评分低（P〈0.05）。（2）术后第4个月和6个月三组间术后静止性疼痛评分无统计学差异（P〉0.05）;但运动性疼痛PG1组比C组的评分低（P〈0.05）。（3）疼痛性质比较：术后2个月：PG1组及PG2组比C组神经病理性疼痛发生率降低（P〈0.05）,主要体现在烧灼痛以及电击样疼痛发生率降低（P〈0.05）。结论：围术期口服普瑞巴林超前镇痛可以缓解非小细胞肺癌根治术患者术后两个月的静息痛和运动痛;并能缓解这类患者术后半年的运动痛;能降低这类患者术后两个月的神经病理性疼痛的发生率。

Objective： To explore whether perioperative oral pregabalin could reduce the development of chronic neuropathic pain after non-small-cell lung cancer radical surgery. Methods： Ninety patients were involved in the randomized, placebo-controlled, double-blind trial（20~65 years old, ASA Ⅰ- Ⅱ, prepared to receive elective lung cancer radical resection patients）. Seventy-four cases completed this trial. Group PG1 patients（n = 23） received 300 mg pregabalin orally 2 hours prior to surgery and 150 mg twice daily for 5 days after the surgery. Group PG2 patients（n = 21） received 300 mg pregabalin 2 hours prior to surgery and 75 mg twice daily for 5 days after the surgery. As control, Group C patients（n = 30） received placebo only. Each patient was given patient controlled intravenous analgesia（PCIA） after surgery. ID pain scale was used to follow-up the patient＇s neuropathic pain occurrence and nature of pain at the 2nd, 4th, and 6th month postoperatively. Results： Compared with group C, static pain or movement pain scores（NRS） in group PG1 and PG2 were much lower 2 months postoperatively（P〈0.05）. Besides, movement pain score（NRS） in group PG1 was lower than group C 6 months postoperatively（P〈0.05）. Incidence of neuropathic pain is significantly lower 2 months postoperatively in the pregabalin group（PG1 and PG2） compared with placebo group（P〈0.05）. The incidence of burning pain and electric shock-like pain was less frequent in the pregabalin group compared with placebo group（P〈0.05）. Conclusion： Preemptive analgesia involving oral pregabalin perioperatively can relieve the static and neuropathic pain 2 months postoperatively in radical resection of lung cancer patients, which can also ease the moving pain of these patients 6 months postoperatively.