超声引导下椎旁神经阻滞联合利多卡因凝胶贴膏治疗带状疱疹后神经痛疗效观察

  目的  分析超声引导下椎旁神经阻滞联合利多卡因凝胶贴膏治疗胸背部带状疱疹后神经痛的临床疗效及安全性。  方法  选择2020年10月—2021年12月蚌埠医学院第一附属医院疼痛科收治的80例胸腰段带状疱疹后神经痛患者，按照随机数字表法分为对照组和治疗组，每组40例。对照组采取超声引导下椎旁神经阻滞治疗，治疗组采取超声引导下椎旁神经阻滞联合利多卡因凝胶贴膏治疗。比较2组治疗前(T0)及治疗1周后(T1)、2周后(T2)、3周后(T3)、4周后(T4)、8周后(T8)的视觉模拟评分(VAS评分)和匹兹堡睡眠质量指数(PSQI)，比较2组普瑞巴林使用剂量和不良反应发生率。  结果  治疗组T1、T2、T3、T4、T8时间点的VAS评分分别为(5.20±0.82)分、(3.90±0.77)分、(3.58±0.76)分、(2.62±0.69)分、(1.98±0.48)分，均低于对照组的(6.03±1.07)、(4.95±0.81)分、(4.03±0.83)分、(3.05±0.76)分、(2.55±0.50)分(均P＜0.05)。治疗后相同时间点治疗组的PSQI较对照组明显降低，差异有统计学意义(均P＜0.05)。治疗组治疗有效率为77.5%(31/40)，优于对照组的50.0%(20/40)，差异有统计学意义(P＜0.05)。  结论  超声引导下椎旁神经阻滞联合利多卡因凝胶贴膏可以有效缓解带状疱疹后神经痛，改善患者睡眠质量，安全性较好。 

Efficacy observation of ultrasound-guided paravertebral nerve block combined with lidocaine gel plaster in the treatment of postherpetic neuralgia

  Objective  To analyze the clinical efficacy and safety of ultrasound-guided paravertebral nerve block combined with lidocaine gel plaster in the treatment of chest and back postherpetic neuralgia.  Methods  A total of 80 patients with thoracolumbar post-herpetic neuralgia admitted to the Department of Pain, the First Affiliated Hospital of Bengbu Medical College from October 2020 to December 2021 were randomly divided into control group and treatment group according to the random number table method, with 40 patients in each group. The control group was treated with ultrasound-guided paravertebral block, and the treatment group was treated with ultrasound-guided paravertebral block combined with lidocaine gel plaster. The visual analog scale (VAS) score and Pittsburgh sleep quality index (PSQI), the dosage of pregabalin and the incidence of adverse reactions were compared between the two groups before treatment (T0), 1 week after treatment (T1), 2 weeks after treatment (T2), 3 weeks after treatment (T3), 4 weeks after treatment (T4) and 8 weeks after treatment (T8).  Results  The VAS scores of treatment groups at T1, T2, T3, T4 and T8 were (5.20±0.82) points, (3.90±0.77) points, (3.58±0.76) points, (2.62±0.69) points, (1.98±0.48) points respectively, which were lower than those in the control group [(6.03±1.07) points, (4.95±0.81) points, (4.03±0.83) points, (3.05±0.76) points and (2.55±0.50) points, all P < 0.05]. The PSQI of the treatment group was significantly lower than that of the control group at the same time point, and the difference was statistically significant (all P < 0.05). The effective rate of the treatment group was 77.5% (31/40), better than that of the control group [50.0% (20/40)], and the difference was statistically significant (P < 0.05).  Conclusion  Ultrasound-guided paravertebral nerve block combined with lidocaine gel patch can effectively relieve postherpetic neuralgia and improve sleep quality of patients with good safety.