The Effectiveness of Repetitive Paravertebral Injections with Local Anesthetics and Steroids for the Prevention of Postherpetic Neuralgia in Patients with Acute Herpes Zoster
The Effectiveness of Repetitive Paravertebral Injections with Local Anesthetics and Steroids for the Prevention of Postherpetic Neuralgia in Patients with Acute Herpes Zoster
复制标题
重复椎旁注射局部麻醉药和类固醇对预防急性带状疱疹患者带状疱疹后神经痛的有效性
DOI：
10.1213/ane.0b013e3181b79075
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发表时间：
2009-11-01
影响因子：
5.7
通讯作者：
Xiong, Lize
中科院分区：
文献类型：
--
作者：
Ji, Genlin;Niu, Jiyuan;Xiong, Lize
背景：带状疱疹后神经痛（PHN）的治疗仍然是临床疼痛管理的一个挑战。在这项随机对照研究中，我们评估了反复椎旁注射局麻药和类固醇预防急性带状疱疹患者PHN的有效性。方法：132名在皮疹发作后1-7天被诊断出患有急性带状疱疹的患者被随机分配接受标准治疗（口服抗病毒药物和镇痛药）或标准治疗，并额外重复椎旁注射10 mL 0.25%布比卡因和40毫克醋酸甲泼尼龙的混合物每48小时一次，持续一周。在治疗结束后1、3、6和12个月评价疗效。主要终点是入选后1个月出现带状疱疹相关疼痛和/或异常性疼痛的患者比例。基于意向治疗人群进行统计分析。结果：113例患者完成了1年随访。在治疗后1个月，椎旁组有13%的患者报告了带状疱疹相关疼痛，而标准组为45%（P < 0.001）。在治疗后3、6和12个月，椎旁组的PHN发生率仍显著低于标准组。在每个随访时间点，两组的生活质量均有所改善，组间无显著差异。结论：重复椎旁麻醉阻滞联合类固醇加阿昔洛韦和镇痛剂的标准治疗比单独标准治疗显著降低PHN的发生率。
BACKGROUND: The treatment of postherpetic neuralgia (PHN) continues to be a challenge in clinical pain management. In this randomized, controlled study, we assessed the effectiveness of repetitive paravertebral injections with local anesthetics and steroids for the prevention of PHN in patients with acute herpes zoster. METHODS: One hundred thirty-two patients with acute herpes zoster diagnosed 1–7 days after the onset of the rash were randomly assigned to receive either standard therapy (oral antivirals and analgesics) or standard therapy with additional repetitive paravertebral injections of a mixture of 10 mL 0.25% bupivacaine and 40 mg methylprednisolone acetate every 48 h for a week. Efficacy was evaluated at 1, 3, 6, and 12 mo after the end of the treatments. The primary end point was the proportion of patients with zoster-associated pain and/or allodynia 1 mo after inclusion. Statistical analysis was performed based on the intent-to-treat population. RESULTS: One hundred thirteen patients completed the 1-yr follow-up. At 1 mo posttherapy, 13% of patients in the paravertebral group reported zoster-related pain, compared with 45% in the standard group (P < 0.001). At 3, 6, and 12 mo posttherapy, the incidence of PHN was still significantly lower in the paravertebral group than in the standard group. The quality of life improved in both groups at each follow-up time point with no significant difference between groups. CONCLUSION: Repetitive paravertebral anesthetic block in combination with steroids plus standard treatment with acyclovir and analgesics significantly reduced the incidence of PHN than the standard treatment alone.