Comparación de la eficacia en el alivio de dolor neuropático crónico agudizado con oxicodona más lidocaína intravenosas frente a tramadol más lidocaína intravenosas

摘要

Objective: We evaluated the efficiency of oxycodone plus lidocaine in comparison with tramadol plus lidocaine in continuous infusion in relieving acute neuropathic pain. Material and methods: Approval was granted by the local ethics committee of the General Hospital of Mexico (Num DIC/08/203/03/070) to perform a prospective, longitudinal, randomized, experimental clinical trial at the pain clinic and palliative care center. Twenty-seven patients with a diagnosis of moderate-to-severe spontaneous acute neuropathic pain of any cause with onset at least 1 month previously, visual analogue scale of four or more, and no exclusion criteria were distributed in two groups: a study group (n = 14) which received oxycodone (10 mg) plus lidocaine (3 mg per kg) in continuous infusion and a control group (n = 13) which received tramadol (100 mg) plus lidocaine (3 mg per kg) in continuous infusion. Demographic variables, pain characteristics, diagnostic category, visual analogue scale for spontaneous pain, tactile allodynia, cold allodynia and hyperalgesia, level of sedation, adverse effects, treatment satisfaction and cardiovascular parameters were evaluated. The statistical analysis was performed with the Chi-squared test and the Mann-Whitney U-test using the SPSS version 11 statistical package. Results: The group treated with continuous infusion of oxycodone plus lidocaine showed significant changes in spontaneous pain at phases 7 and 8 of the study (p < 0.05). Significant changes were also found in diastolic blood pressure at phase 8 (p < 0.001). No significant changes were found in the level of sedation, the incidence of adverse effects or treatment satisfaction. No significant changes were found in heart rate or blood pressure in either of the two groups during the distinct study phases (p > 0.05). Conclusions: Continuous infusion of oxycodone plus lidocaine was safe, as demonstrated by cardiovascular stability, and had analgesic effects in relieving acute neuropathic pain compared with the control group. Further studies with a larger number of patients are required to validate these results.