神经阻滞联合药物治疗老年胸背部带状疱疹后神经痛的临床观察

目的观察椎旁神经阻滞及皮损区局部浸润联合药物和心理学综合疗法对老年胸背部带状疱疹后神经痛的疗效.方法选择老年胸背部带状疱疹后神经痛患者43例.皮损分布区T2～T9.采用椎旁神经阻滞、皮损区局部浸润联合全身应用复方甘草酸苷、消炎镇痛药及心理治疗.以视觉模拟评分(VAS)和睡眠质量评分(QS)综合评定治疗效果.结果治疗前VAS为(8.57±0.61)分,QS为(3.62±0.31)分;治疗后1～4周VAS评分和QS评分均明显降低,与治疗前比较有显著性差异(P＜0.01);显效率为88.3%,总有效率为100%.结论以椎旁神经阻滞和皮损区局部浸润为主,联合药物和心理学治疗对缓解带状疱疹后神经痛和改善睡眠质量,疗效显著而安全.     

7神经阻滞联合药物治疗老年胸背部带状疱疹后神经痛的临床观察

目的　观察椎旁神经阻滞及皮损区局部浸润联合药物和心理学综合疗法对老年胸背 部带状疱疹后神经痛的疗效。方法　选择老年胸背部带状疱疹后神经痛患者43例。皮损分布区T2 ～T9。采用椎旁神经阻滞、皮损区局部浸润联合全身应用复方甘草酸苷、消炎镇痛药及心理治疗。 以视觉模拟评分(VAS)和睡眠质量评分(QS)综合评定治疗效果。结果　治疗前VAS为(8.57± 0.61)分,QS为(3.62±0.31)分;治疗后1～4周VAS评分和QS评分均明显降低,与治疗前比较有 显著性差异(P<0.01);显效率为88.3%,总有效率为100%。结论　以椎旁神经阻滞和皮损区局部 浸润为主,联合药物和心理学治疗对缓解带状疱疹后神经痛和改善睡眠质量,疗效显著而安全。     

加巴喷丁联合神经阻滞预防老年带状疱疹后神经痛

目的:探讨加巴喷丁联合神经阻滞预防老年带状疱疹后神经痛的效果.方法:将60例75岁以上老年带状疱疹未发生神经痛的患者按就诊顺序分成2组,分为接受神经阻滞组(A组)和口服加巴喷丁联合神经阻滞组(B组),用视觉模拟评分(VAS)和24 h睡眠时间评价治疗效果.结果:在4周的随访时间内,B组各时点疼痛评分与A组相比随时间下降,睡眠时间增加﹙P<0.05﹚.B组VAS评分下降和24 h睡眠时间增加大A组﹙P<0.05﹚.结论:加巴喷丁联合神经阻滞能降低老年带状疱疹后神经痛程度,改善睡眠质量.     

背根神经节射频联合加巴喷丁治疗带状疱疹后神经痛

目的观察背根神经节射频联合加巴喷丁治疗带状疱疹后神经痛的疗效及安全性。方法将东莞市东城医院2014-01—2016-12间收治的60例带状疱疹后神经痛患者随机分为2组,对照组给予加巴喷丁联合神经阻滞治疗,观察组给予背根神经节射频联合加巴喷丁治疗。结果治疗前2组患者的VAS评分、睡眠质量(匹兹堡睡眠质量指数问卷)评分比较,差异均无统计学意义(P0.05)。治疗后观察组患者的VAS评分、睡眠质量评分均较对照组患者低,差异有统计学意义(P0.05)。治疗期间2组患者的不良反应发生率差异无统计学意义(P0.05)。结论背根神经节射频联合加巴喷丁治疗带状疱疹后神经痛,疗效确切,安全性高。     

星状神经节阻滞治疗头面部带状疱疹后神经痛的疗效观察

目的:探讨星状神经节阻滞(SGB)治疗头面部带状疱疹后神经痛(PHN)的临床效果.方法:将48例头面部带状疱疹后神经痛患者随机分成观察组与对照组各24例,分别使用星状神经节阻滞治疗与传统基础疗法并进行疗效比较.结果:观察组疗效及显效、痊愈时间显著优于对照组(P<0.05,P<0.01).结论:星状神经节阻滞治疗头面部带状疱疹性神经痛具有疗效好,安全性高,无明显副作用等优点,值得推广.     

加巴喷丁联合星状神经节超激光照射治疗头面部带状疱疹后神经痛的疗效分析

目的：评估加巴喷丁联合星状神经节超激光照射治疗头面部带状疱疹后神经痛的疗效。方法：60例病人随机分A、B、C 3组,进行为期21 d的治疗。A组单服加巴喷丁900 mg/d;B组除服药外,联合星状神经节阻滞每周2次;C组联合超激光星状神经节照射,每周5次。分析各组治疗前和治疗后第3、7、14、21天病人疼痛视觉模拟评分（VAS）的变化,比较每组病人的补救用药、不良反应的发生率以及治疗结束时的总有效率。结果：3组病人治疗后第3天与治疗前相比VAS明显降低（A组：t=13.1,P〈0.01;B组：t=5.2,P〈0.01;C组：t=18.5,P〈0.01）,治疗第3、7天B组VAS明显低于A、C组（第3天：F=4.1,P=0.02;第7天：F=4.4,P=0.02）,第14、21天,B组和C组VAS显著低于A组（第14天：F=5.0,P=0.01;第21天：F=3.9,P=0.02）。治疗后第3天,A、B、C 3组补救用药率分别为40%、5%和15%（X2=7.5,P=0.027）,之后无统计学差异。治疗结束时,各组总有效率没有差异,但完全缓解率B、C组明显优于A组（X2=11.6,P=0.04）,不良反应发生率B组高达30%,C组仅为15%。结论：加巴喷丁联合星状神经节超激光照射的疗效优于单用加巴喷丁治疗,治疗2周后疗效和加巴喷丁联合星状神经节阻滞相似,是一种治疗头面部带状疱疹后神经痛安全、无创和有效的方法。     

硬膜外输注地塞米松-布比卡因-芬太尼混合液联合牛痘疫苗致炎兔皮提取物治疗重度带状疱疹神经痛的效果

目的 评价硬膜外输注地塞米松-布比卡因-芬太尼混合液联合牛痘疫苗致炎兔皮提取物治疗重度带状疱疹神经痛的效果.方法 带状疱疹神经痛患者48例,性别不限,年龄45-92岁,疼痛视觉模拟评分(VAS)＞ 6分,采用随机数字表法,将其随机分为2组(n=24):常规药物组(C组)与硬膜外阻滞联合牛痘疫苗致炎兔皮提取物组(T组).2组治疗期间均静脉输注牛痘疫苗致炎兔皮提取物6 ml/d,C组还口服阿米替林和加巴喷丁,T组选择带状疱疹病毒感染最严重的脊神经节段的相应椎间隙硬膜外穿刺,硬膜外输注药物配方0.075％布比卡因、芬太尼2μg/ml和地塞米松50 μg/ml,生理盐水稀释至100ml,速率2～5 ml/h,连续10d,维持VAS评分≤4分.记录硬膜外给药期间与硬膜外给药相关不良反应和带状疱疹后神经痛的发生情况.结果 与C组比较,T组尿潴留和带状疱疹后神经痛的发生率降低(p＜0.05或0.01).T组未见其他不良反应.结论 硬膜外输注地塞米松-布比卡因-芬太尼混合液联合牛痘疫苗致炎兔皮提取物可有效地缓解严重带状疱疹神经痛,预防带状疱疹后神经痛的发生,且安全性良好.     

超声引导后路肋间神经阻滞对带状疱疹性神经痛患者的疗效

目的 评价超声引导后路肋间神经阻滞对带状疱疹性神经痛患者的疗效.方法 拟行后路肋间神经阻滞的胸背部带状疱疹性神经痛患者48例,性别不限,年龄56～84岁,体重48～83 kg病程＜30 d.后路肋间神经阻滞用药:0.75%罗哌卡因10ml+确炎舒松A 20 mg+2%亚甲蓝2ml,用0.9%生理盐水配制成20ml.采用便携超声仪和高频直线探头(6～13 MHz)或腹部扇形探头(2～5 MHz),采用超声引导长轴平面内技术,穿刺针尖到达胸膜外,近肋骨下阴影区域时,回吸注射器无回血后,根据带状疱疹分布阻滞肋间神经,每束肋间神经注射镇痛药3ml.于治疗前、治疗后1、2、4和8周采用VAS评分法评价疼痛程度,计算疼痛缓解度,采用生活质量评分法评价生活质量;于治疗后8周进行镇痛疗效分级,计算治疗有效率和显效率,记录并发症的发生情况.结果 操作过程中均未发生穿刺针误穿胸膜,阻滞后患者均未发生胸闷或呼吸困难.治疗后各时点VAS评分降低,生活质量升高,疼痛缓解度逐渐升高(P＜0.05或0.01).治疗后8周有效率96%,显效率83%.结论 超声引导后路肋间神经阻滞对带状疱疹性神经痛患者的疗效确切,不良反应少,改善了生活质量.

Abstract：

Objective To evaluate ultrasound-guided posterior approach to intercostal block for herpetic neuralgia. Methods Forty-eight patients with herpetic neuralgia after appearance of rashes on the back of chest (the coursc ＜ 30 days) aged 56-84 yr received intercostal block performed via posterior approach under the guidance of ultrasound with a mixture of 0.75% ropivacaine, glucocorticoid and methylene blue. Pain was assessed with visual analogue scale (VAS) before block and at 1, 2, 4 and 8 weeks after block. Pain relief (PAR) was cal-culated (PAR= (VAS score before block- VAS score after block) ÷ VAS score before block × 100%). Results No patient developed dyspnea and pneumothorax. VAS scores were reduced significantly, quality of life was improved and PAR increased at 1, 2, 4 ancl 8 weeks after block ( P ＜ 0.05 or 0.01). Concluslon Ultracound-guided posterior approach to intercostal block is safe and effective for the treatment of herpetic neuralgia.     

脉冲射频、神经阻滞联合使用对带状疱疹后遗神经痛的治疗观察

目的探讨脉冲射频联合神经阻滞治疗带状疱疹后遗神经痛的效果。方法将72例带状疱疹后遗神经痛患者随机分为2组,各36例。在口服加巴喷丁基础上,对照组给予神经阻滞治疗,观察组给予神经阻滞+脉冲射频治疗。比较2组疗效。结果观察组有效率为97. 22%(35/36),对照组为88. 89%(32/36),2组差异无统计学意义(P0. 05)。观察组优良率为91. 67%(33/36),高于对照组的72. 22%(26/36),差异有统计学意义(P 0. 05)。结论脉冲射频联合神经阻滞治疗带状疱疹后遗神经痛,可有效缓解患者疼痛。     

超激光照射联合神经阻滞治疗带状疱疹性神经痛

我们应用超激光(红外直线偏振光)局部照射和神经阻滞联合治疗头颈部、颈肩部、胸腰背部带状疱疹性神经痛,取得了良好的疗效,现报道如下. 资料与方法 一般资料我们在2007～2008年收治的带状疱疹(AHZ)以及带状疱疹后神经痛(PHN)患者30例,男17例,女13例,年龄55～86岁,病程10 d～8个月,VAS评分7～10分.     

加巴喷丁缓释片治疗带状疱疹后神经痛效果的Meta分析

目的系统评价加巴喷丁缓释片单次服用和分次服用治疗带状疱疹后神经痛(postherpetic neuralgia,PHN)的临床效果。方法电子检索Cochran图书馆临床对照试验资料库、PubMed、EMbase、中国生物医学数据库、维普、知网及万方数据库,收集比较加巴喷丁缓释片单次服用和分次服用治疗PHN的随机对照试验(RCT)。采用RevMan5.0软件对数据进行Meta分析。结果有2篇RCT论文符合标准纳入分析,共379例患者。Meta分析结果显示:(1)加巴喷丁缓释片单次服和分次服相比治疗PHN的有效性差异无统计学意义;(2)加巴喷丁缓释片单次服和分次服相比治疗PHN的不良反应的发生率差异无统计学意义。结论加巴喷丁缓释片单次和分次服用治疗PHN的效果和不良反应相同。     

Acute herpetic neuralgia and postherpetic neuralgia in the head and neck: response to gabapentin in five cases

BACKGROUND AND OBJECTIVES: The clinical presentations and pharmacologic management of three patients with acute herpetic neuralgia (AHN) and two patients with postherpetic neuralgia (PHN), confined to the head and neck region, are described. METHODS: Two patients had pain in the ophthalmic division of the trigeminal nerve, two had pain confined to the C2-C4 dermatomes, and one patient had C2 pain with radiating and referred pain to the second and third divisions of the trigeminal nerve. RESULTS: Gabapentin, an anticonvulsant drug, was effective in treating these patients, including the two cases of AHN. All patients reported complete pain relief after titration with gabapentin up to 1,800 mg/d. The patients noted a dose-dependent decrease in pain almost immediately after starting gabapentin. Specifically, reduction in the frequency and intensity of allodynia, burning pain, shooting pain, and throbbing pain were noted. None of the patients experienced side effects from the drug. CONCLUSIONS: In view of the results in these patients, blinded, controlled studies are needed to determine the efficacy of gabapentin for treating AHN and PHN.     

糖皮质激素对椎旁阻滞治疗带状疱疹后神经痛疗效的影响

目的 观察糖皮质激素对椎旁阻滞治疗胸背部带状疱疹后遗神经痛(post-herpetic neuralgia,PHN)疗效的影响.方法 选择病变累及范围在T1～T12的顽固性PHN(带状疱疹后疼痛持续大于3个月且VAS大于7分)患者80例,随机数字表法分为神经妥乐平+复方倍他米松注射液椎旁阻滞组(激素组)及神经妥乐平椎旁阻滞组(非激素组)(每组40例).分别每2周行1次椎旁阻滞治疗,每位患者连续治疗4次,观察患者每次治疗后疼痛改善情况、疗程结束时.发痛发作频率及副作用.结果 两组患者每次治疗后疼痛较前一次均有明显缓解(P＜0.05),疗程结束时两组患者疼痛症状较治疗前明显改善(P＜0.01),部分爆发痛缓解明显,均未出现明显副作用;两组间比较,无论是各时间节点疼痛缓解还是爆发痛发作频率,差异均无统计学意义(P＞0.05). 结论 椎旁阻滞时加入糖皮质激素治疗PHN疗效并不优于不加糖皮质激素阻滞.     

Effective treatment of acute pain and related symptoms in elderly with herpes zoster

BACKGROUND: The incidence of herpes zoster increases with age. Immediate pain relief is required for prevention of postherpetic neuralgia (PHN) and also its related symptoms that worsen the general condition because acute herpetic pain often interferes with sleep, mood, and general activities in elderly patients. Nerve block is useful to relief acute pain and recommended for prevention of PHN. Tricyclic antidepressant drugs have antinoticeptive effect in acute pain in experimental models, in addition to its antidepressant effect. METHODS: Forty elderly patients with herpes zoster within 3 months after the onset underwent nerve blocks and received tricyclic antidepressant drugs. We assessed the effect of treatments and adverse effects. RESULTS: No significant adverse effects were found in elderly patients who had received nerve blocks and/or tricyclic antidepressant drugs. Alleviation of acute pain was obtained in more than 80% of patients, and in all patients depressive state and/or disturbance of the general condition were significantly improved. CONCLUSIONS: With careful technique and assessment of patients, both nerve block and tricyclic antidepressant drugs were beneficial and safe treatments in elderly patients with herpes zoster.     

Relief of pain in acute herpes zoster by nerve blocks and possible prevention of post-herpetic neuralgia

PURPOSE: This report describes two cases of acute herpes zoster (AHZ) treated by nerve block resulting in immediate pain relief and possible prevention of post-herpetic neuralgia (PHN). CLINICAL FEATURES: Two elderly females with AHZ of cervical dermatomes and severe pain received deep cervical and greater occipital nerve blocks with a local anesthetic, epinephrine and steroid. In both patients, pain resolved immediately and permanently (one year follow-up) after a single treatment.Case #1: A 79-yr-old female with a mechanical mitral valve and anticoagulated with warfarin presented with AHZ of 17 days duration of the right C2, 3, 4 dermatomes and severe pain. A stellate ganglion block was not performed because of anticoagulation. Rather, a deep cervical root block at C3 and a greater occipital nerve block were performed with bupivacaine, epinephrine and methylprednisolone. No adverse events were evident. Case #2: A 73-yr-old female with a history of osteoarthritis and Meniere's disease presented with AHZ of seven days duration of the left C2, 3, 4 dermatomes and severe pain. Deep cervical root blocks at C3 and C4 and a greater occipital nerve block were performed with bupivacaine, epinephrine and methylprednisolone. Side effects of dizziness, hoarseness, hypertension and Horner's syndrome resolved in a few hours. A mild sensation of itching persisted for two weeks. CONCLUSION: This report illustrates the potential of nerve blocks in severe AHZ to treat acute pain and possibly prevent PHN.     

A clinical study of paraspinal nerve block on treatment of herpes zoster under ultrasonic guidance

ObjectiveTo study the ultrasound guiding by methylenum coeruleum thoracic paravertebral block analgesia effect and promote healing of herpes zoster.MethodsA total of 87 patients with herpes zoster were randomly divided into an observation group and a control group, and the two groups received the same treatment including antiviral drug, nerve nutrition, in order to increase the body's resistance. The observation group were given thoracic paravertebral block with methylenum coeruleum guided by ultrasound, recorded visual analogue scale (VAS) of the two groups of patients for their hypersensitivity to pain 1d, 3d, 1 week, 2 weeks, 1 month after treatment, skin lesion healing time, incidence of postherpetic neuralgia (PHN), patients’ satisfaction, etc.ResultsAfter administration of thoracic paravertebral block with methylenum coeruleum, VAS of the observation group expectedly decreased. At the same time, the VAS in the observation group was significantly lower than that in the control group, the skin healing time in the observation group was obviously shorter, and the incidence of PHN was lower than that in the control group. The satisfaction of observation group patients was higher than that in the control group (P < 0.05).ConclusionTo implement thoracic paravertebral block with methylenum coeruleum guided by ultrasound can help reduce the degree of hypersensitivity to pain, promoting the healing of herpes zoster could reduce the incidence of PHN, greatly improving patients’ satisfaction.     

臭氧联合颈椎旁神经阻滞治疗颈源性头痛的临床疗效观察

目的 评估臭氧联合颈椎旁神经阻滞治疗颈源性头痛的临床疗效.方法 对2009-09-2011-09我院疼痛门诊178例颈源性头痛患者进行了臭氧联合颈椎旁神经阻滞,将患者分为对照组(n=88)和治疗组(n=90),治疗组采用臭氧联合颈椎旁神经阻滞,对照组仅使用颈椎旁神经阻滞,通过对患者进行视觉疼痛评分比例尺(VAS)和临床表现进行临床疗效观察.结果 两组患者治疗后VAS评分均有明显的降低,治疗组评分的下降更为明显,两组之间差异具有显著性(P＜0.05);治疗组的痊愈率和好转率较高,两组之间差异具有显著性(P＜0.05).结论 臭氧联合颈椎旁神经阻滞是临床上比较确切的治疗方法,疗效优于单纯颈椎旁神经阻滞治疗颈源性头痛.     

Postherpetic neuralgia

Varicella-zoster virus (VZV) causes two clinically distinct diseases: varicella and herpes zoster. Herpes zoster, recurrent infection of VZV occurs when the cell-mediated immunity to VZV declines. Since the cell-medicated immunity to VZV declines with aging, herpes zoster occurs more frequently in the elderly. Most frequent and dreaded complication of herpes zoster is postherpetic neuralgia (PHN). The first line of treatment of PHN is medication with tricyclic antidipressants and anticonvulsants. Double-blind studies showed that effective tricyclic antidepressants for the treatment of PHN are amitriptyline and nortriptyline, and effective anticonvulsants gabapentin and pregabalin. When tricyclic antidepressant and/or anticonvulsant cannot relieve PHN, opioids should be considered in some selected patients. Although neuroablative procedures have been performed for the treatment of PHN, their effectiveness was not confirmed by double-blind studies. They rather aggravate PHN with time. Recent research with a live attenuated varicella vaccine to prevent herpes zoster indicated that the vaccine decreased the occurrence of herpes zoster and postherpetic neuralgia by almost half as compared with placebo. Vaccination of high risk subjects with the varicella vaccine seems to be the most effective measure for the prevention of postherpetic neuralgia.     

比较神经阻滞与腰-硬联合麻醉对老年腹股沟斜疝患者术中血流动力学的影响

目的比较神经阻滞与腰-硬联合麻醉对老年腹股沟斜疝患者术中血流动力学指标等的影响。 方法选取2016年5月至2018年5月，湖南中医药大学第一附属医院86例老年腹股沟斜疝患者的临床资料，按照麻醉方式不同分为腰-硬联合组（43例）和神经阻滞组（43例）。所有患者均接受择期手术治疗，腰-硬联合组患者予以布比卡因进行腰-硬联合麻醉，神经阻滞组患者则于超声指导下予以罗哌卡因及右美托咪定进行神经阻滞。观测并比较2组患者的血流动力学指标、麻醉效果和不良反应发生率。 结果2组患者在各时间点的平均动脉压、呼吸频率及血氧饱和度血压水平比较，差异无统计学意义（P>0.05）。切皮（T1）时神经阻滞组心率较腰-硬联合组明显降低，差异有统计学意义（P<0.05）；但其余时间2组患者HR比较，差异无统计学意义（P>0.05）。神经阻滞组的切皮时视觉模拟评分均显著低于腰-硬联合组，而神经阻滞组的感觉阻滞持续时间和Ramsay镇静评分均显著高于腰-硬联合组，但腰-硬联合组的感觉阻滞起效时间较神经阻滞组要短，差异均有统计学意义（P<0.05）。治疗后，神经阻滞组的不良反应发生率（6.98%）显著低于腰-硬联合组（23.36%），差异有统计学意义（P<0.05）。 结论老年腹股沟斜疝患者在手术治疗过程中，神经阻滞较腰-硬联合麻醉的麻醉效果要好，可产生较好的镇痛、镇静作用，不良反应发生率较小，值得临床推广应用。     

Neuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence

BACKGROUND AND OBJECTIVES: Epidural, intrathecal, and sympathetic blocks are used for the treatment of pain caused by herpes zoster (HZ) and postherpetic neuralgia (PHN). This study was undertaken to evaluate and synthesize existing evidence for using these nerve blocks with various injectates (local anesthetic [LA] alone, LA + steroids) in treating pain of HZ, PHN (>6 months), and its prevention. METHODS: A computerized search of published trials in the English language from 1966 to 2001 was carried out on Medline, EMBASE, and Cochrane Clinical Trial databases. Levels of evidence and grades of recommendations were made based on criteria published by the Oxford Centre for Evidence-Based Medicine. RESULTS: Among the studies meeting inclusion criteria, treatment was initiated during acute pain in 71% (15/21) and PHN in 29% (6/21). Randomized controlled trials (RCTs, level 1b evidence) constituted 19% (4/21), individual cohort (levels 2b, 3b) 29% (6/21), and case series (level 4) 43% (9/21). Overall, 80% (15/21) of trials showed a positive outcome with these blocks. The use of sympathetic (LA) and epidural blocks (LA + steroid) for pain of HZ was supported by 1 RCT each, and intrathecal block (LA + steroid) for PHN was supported by 2 RCTs. CONCLUSIONS: Evidence for the beneficial effect of epidural LA + steroid in HZ, and intrathecal LA + steroid in PHN appears to be consistent (grade A). If given within 2 months of HZ, epidural LA + steroid may reduce the incidence of PHN after 1 year (grade A). Evidence for use of sympathetic blocks in HZ and PHN, although generally useful (Grade B), requires RCTs for validation.