预用局部浸润麻醉对瘢痕疙瘩内药物注射疼痛的影响

Effect of pre-emptive local infiltration anesthesia on pain caused by drug injection in keloid

目的 观察预用局部浸润麻醉对瘢痕疙瘩皮损内药物注射疼痛的影响。方法 自2019年10月至2021年12月,苏州明基医院美容整形外科收治46例(92个区域)瘢痕疙瘩患者,以随机数字表法分为观察组和对照组,46个区域/组,并且采用随机数字表法设定每一患者2种注射方法的先后次序。观察组预用局部浸润麻醉后对瘢痕疙瘩内注射药物;对照组常规注射。采用视觉模拟量表(visual analogue scale, VAS)评价两组疼痛程度和重度疼痛的比例。统计比较两组治疗时长。对照组VAS评分数据以年龄为检验结果变量,绘制受试者工作特征(receive operating characteristic curve, ROC)曲线。结果 观察组VAS评分为(6.41±1.79)分,对照组为(8.29±1.74)分,经配对t检验两组差值为(-1.88±1.05)分,差异有统计学意义(P<0.05)。观察组治疗时长为(10.68±5.05)min,对照组为(7.02±3.95)min,两组差值为(3.66±1.64)min,差异有统计学意义(P<0.05)。观察组的重度疼痛比例为41.30%,对照组为86.96%,差异有统计学意义(P<0.05)。对照组VAS评分数据以年龄为检验结果变量,ROC曲线分析结果:ROC曲线下面积为0.917,标准误为0.070,95%CI为(0.779,1.000)。以50岁为临界值预测轻中度疼痛,其敏感度(sensitivity,SEN)为83.3%,特异度(specificity,SPE)为97.5%,约登指数为0.808,较其他临界值更大。结论 预用局部浸润麻醉可以有效减轻瘢痕疙瘩内药物注射的疼痛程度,可提高患者接受度并且完成必要的多次治疗。预用局部浸润麻醉使治疗时长平均增加数分钟,患者可接受,值得临床应用推广。以50岁为临界值预测轻中度疼痛较适合。

Objective To observe effect of pre-anaesthesia with local infiltration on pain of intradermal drug injection in keloid scars.Methods From October 2019 to December 2021,Department of Plastic Surgery,Suzhou Mingji Hospital admitting 46 patients(92 regions)with keloids.They were divided into observation group and control group using a random number table,46 regions each group.The sequence of two injection methods for each case was set by a random number table.Evaluate the degree of pain and the proportion of severe pain in both groups using the Visual Analog Scale(VAS).The treatment duration of the two groups was statistically compared.The VAS score data of the control group were tested using age as the result variable,and the ROC curve was plotted.Results The VAS score was(6.41±1.79)in the observation group and(8.29±1.74)in the control group,after paired t-test,the difference between the two groups was(-1.88±1.05),the difference was statistically significant(P<0.05).The treatment duration of the observation group was(10.68±5.05)minutes,while the control group was(7.02±3.95)minutes.The difference between the two groups was(3.66±1.64)minutes,with a statistically significant difference(P<0.05).The proportion of severe pain in the observation group was 41.30%,while the proportion of severe pain in the control group was 86.96%,the difference was statistically significant(P<0.05).The VAS score data of the control group was tested using age as the outcome variable.The ROC curve analysis results showed that the area under the ROC curve(AUC)was 0.917,with a standard error of 0.070,and a 95%confidence interval of(0.779,1.000).The sensitivity(SEN)of predicting mild to moderate pain at the age of 50 is 83.3%,the specificity(SPE)is 97.5%,and the Jordan index is 0.808,which is higher than other critical values.Conclusion Pre-emptive local infiltration anesthesia can effectively alleviate the pain of drug injection in keloid,improve the patient's acceptance and complete the necessary multiple treatments.It is acceptable that pre-emptive local infiltration anesthesia increases the treatment duration by an average of several minutes,which deserves generalization for clinical application.It is more suitable to predict mild to moderate pain at the age of 50 as the threshold.