Efficacy of epidural infusion of a mixture of bupivacaine-fentanyl-dexamethasone on top of intravenous extract from rabbit skin inflamed by vaccinia virus for severe herpetic neuralgia / 中华麻醉学杂志

ABSTRACT

ObjectiveTo evaluate the efficacy of epidural infusion of a mixture of bupivacaine-fentanyl-dexamethasone on top of intravenous extract from rabbit skin inflamed by vaccinia virus (ERSVV) for severe herpetic neuralgia.MethodsForty-eight patients of both sexes with severe herpetic neuralgia aged 45-92 yr were randomly divided into 2 groups (n =24 each)control group (group C) and test group( group T).Both groups received intravenous ERSVV 6 ml/d.Group C received oral amitriptyline and gabapentin,while the group T received epidural infusion of 100 ml of a mixture of 0.075％ bupivacaine,fentanyl 2 μg/ml and dexamethasone 50 μg/ml in normal saline at 2-5 ml/h,once a day for 10 days and VAS score was maintained≤4.Epidural puncture was performed at the spinal segments severely affected by herpes virus.Intensity of pain was assessed with VAS (0 =no pain,10 =worst pain).In group C when VAS ＞ 4 oral amitriptyline 12.5 mg (once/d) and gabapenti 0.1 g (3 times/d) were given as rescue analgesics.Adverse effects of epidural infusion and incidence of post-herpetic neuralgia were recorded.ResultsThe incidence of urinary retention and incidence of post-herpetic neuralgia were lower in group T than in group C.No other adverse effects were found in group T.ConclusionEpidural infusion of a mixture of bupivacaine-fentanyl-dexamethasone on top of ERSVV can effectively reduce severe herpetic neuralgia and prevent development of post-herpetic neuralgia safely.