Ultrasound-Guided Extraforaminal Thoracic Nerve Root Block Through the Midpoint of the Inferior Articular Process and the Parietal Pleura: A Clinical Application of Thoracic Paravertebral Nerve Block.
Ultrasound-Guided Extraforaminal Thoracic Nerve Root Block Through the Midpoint of the Inferior Articular Process and the Parietal Pleura: A Clinical Application of Thoracic Paravertebral Nerve Block.
复制标题
超声引导经下关节突中点和壁层胸膜的椎间孔外胸神经根阻滞：胸椎旁神经阻滞的临床应用
DOI：
10.2147/jpr.s351145
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发表时间：
2022
影响因子：
2.7
通讯作者：
Du D
中科院分区：
文献类型：
--
作者：
Pu S;Wu Y;Han Q;Chen J;Xu Y;Lv Y;Li C;Lu J;Wu J;Du D
目的胸神经根阻滞（TNR）主要在计算机断层扫描或X线透视下进行，但与辐射暴露有关。超声波不需要辐射，可以区分血管、神经、胸膜和其他组织。超声引导TNR（US-TNR）阻滞的报道很少，穿刺终点也没有明确定义。本研究以下关节突（IAP）和壁层胸膜（PP）中点为穿刺点，评价超声TNR阻滞的可行性。患者和方法10例带状疱疹相关疼痛患者接受了US-TNR引导的阻滞，采用平面内技术，以胸部IAP和PP中点作为超声穿刺终点。采用超声作为主要成像工具，然后通过荧光镜确认进行US-TNR阻滞手术。结果所有患者的前后位片上，椎弓根外侧缘可见针尖，侧位片上，椎弓根孔外区可见针尖。10例患者均行TNR和背根神经节（DRG）的勾画。2 mL造影剂可显示8例硬膜外腔和2例胸椎旁间隙。所有患者在注射局麻药后30 min均出现沿着相应皮节的麻木。基线、2周和4周随访时的数字评定量表（NRS）评分分别为6.50 ± 1.35、3.50 ± 0.85（与基线NRS相比，P < 0.01）和4.00 ± 0.82（与基线NRS相比，P < 0.01）。结论以胸段IAP和PP中点为穿刺终点，采用平面内技术进行US-TNR阻滞，可有效阻滞TNR和DRG。该技术是TPV神经阻滞的一种准确的临床应用，为神经病理性疼痛的治疗提供了一种潜在的治疗选择。
Purpose Thoracic nerve root (TNR) block is performed primarily under computed tomography or X-ray fluoroscopy but is associated with radiation exposure. Ultrasound requires no radiation and distinguishes vessels, nerves, pleura, and other tissues. Few reports of ultrasound-guided TNR (US-TNR) block have been described, and the puncture end point has not been clearly defined. Herein, we evaluated the feasibility of US-TNR block using the midpoint of the inferior articular process (IAP) and parietal pleura (PP) as the puncture end point. Patients and Methods A prospective series of 10 patients with Herpes Zoster-associated pain underwent US-TNR-guided block performed using an in-plane technique with the midpoint of thoracic IAP and PP as the puncture end points of ultrasonography. The US-TNR block procedure was performed with ultrasound as the primary imaging tool followed by fluoroscopic confirmation. Results In all patients, the needle tips were visible at the lateral margin of the pedicle in the anteroposterior view and at the extraforaminal zone in the lateral view. The TNR and dorsal root ganglion (DRG) were delineated in all 10 patients. Furthermore, 2 mL of radiopaque agent could delineate the epidural space in 8 patients and the thoracic paravertebral (TPV) space in the other 2 patients. All patients developed numbness along the corresponding dermatome 30 min after injection of local anesthetics. The numeric rating scale (NRS) score at baseline, and at two- and four-week follow-ups were 6.50 ± 1.35, 3.50 ± 0.85 (vs NRS at baseline, P < 0.01), and 4.00 ± 0.82 (vs NRS at baseline, P < 0.01), respectively. Conclusion This study demonstrated the feasibility of US-TNR block using the in-plane technique with the midpoint of thoracic IAP and PP as the puncture end point to effectively block the TNR and DRG. This technique is an accurate clinical application of TPV nerve block and provides a potential therapeutic option for the treatment of neuropathic pain.