Lidocaína endovenosa como coadyuvante en el tratamiento inicial de la neuralgia postherpética: Bases fisiopatológicas del uso de anestésicos locales en el tratamiento del dolor neuropático

摘要

Introduction: Post-herpetic neuralgia is the algic condition that remains when the vesicles of an acute episode of herpes zoster have disappeared after a minimum period of 8-12 weeks. Up to 50% of patients older than 70 years will develop this condition after an acute episode of herpes zoster. Its physiopathological basis is still unclear, so its prevention is difficult and its treatment is aimed to symptoms. Materials and methods: One hundred patients were randomized to one of the study groups (n = 25): group A1, patients < 70 years of age treated with increasing doses of gabapentin; group A2, patients > 70 years of age treated with gabapentin and endovenous lidocaine; group B2, patients > 70 years of age treated with gabapentin and endovenous lidocaine. Pain reported by the patient was assessed at four time points during the first four weeks. Results: Statistically significant differences were observed (p < 0,05) in the mean VAS scores reported by the patients, with a lower VAS score within the groups treated with endovenous lidocaine and in patients < 70 years of age in both groups. Conclusions: The treatment of post-herpetic neuralgia is aimed to symptoms. Local anesthetics have been successfully used for some types of neuropathic pain. Endovenous lidocaine can be useful as co-adjuvant during the initial treatment of post-herpetic neuralgia, since it significantly reduces the VAS score reported by patients. Aged patients had a poorer response to the use of lidocaine, as well as lower mean VAS scores, compared to patients that did not received lidocaine.