ABSTRACT
OBJECTIVES: Ultrasound (US)-guided intercostal nerve block (ICNB) is an easier approach with a very low incidence of complications for different surgeries; nevertheless, only a few studies estimate the effect of ICNB for acute HZ. To explore the US-guided ICNB for management of herpes zoster (HZ)-related acute pain and possible prophylaxis for post-herpetic neuralgia (PHN) taking the conventional thoracic paraverteral block (TPVB) as control. METHODS: A total of 128 patients with HZ were retrospectively stratified into antiviral treatment (AVT) plus US-guided TPVB (TPVB group), AVT plus US-guided ICNB (ICNB group) or AVT alone (control group) based on the treatment they received. HZ-related illness burden (HZ-BOI) over 30 days after inclusion as the primary endpoint was determined by a severity-by-duration composite pain assessment. Rescue analgesic requirement, health-related quality of life, PHN incidence, and adverse events were also recorded. RESULTS: Significantly lower HZ-BOI scores within post-procedural 30 days using the area under the curve were reported with TPVB and ICNB compared with the control group: mean difference of 57.5 (p < 0.001) and 40.3 (p = 0.003). No difference was reported between TPVB and ICNB (p = 1.01). Significant greater improvements in PHN incidence, EQ-5D-3L scores, and rescue analgesic requirements were observed during follow-up favoring two trial groups, while comparable between two trial groups. No serious adverse events were observed. CONCLUSIONS: US-guided ICNBs were as effective as TPVBs for acute HZ. The ICNB technique was an easier and time-efficient approach as opposed to conventional TPVB, which might be encouraged as a more accessible preemptive mean for preventing PHN.
Subject(s)
Herpes Zoster , Intercostal Nerves , Nerve Block , Neuralgia, Postherpetic , Ultrasonography, Interventional , Humans , Neuralgia, Postherpetic/prevention & control , Female , Male , Retrospective Studies , Herpes Zoster/complications , Herpes Zoster/prevention & control , Nerve Block/methods , Ultrasonography, Interventional/methods , Aged , Case-Control Studies , Middle Aged , Intercostal Nerves/drug effects , Pain MeasurementABSTRACT
The purpose of this study was to investigate the general anesthetic requirements in patients with continuous endotracheal-laryngopharynx topical anesthesia using medicine injecting endotracheal tube during surgery. A total of 78 patients with American Society of Anesthesiologists (ASA) physical status I-II were randomly divided into test group and control group. After anesthesia, patients were injected by 1.5 mL of 1% Tetracaine for topical anesthesia, and later injected similarly at hourly intervals during surgery while patients in control group were non-injected. There was no statistical significance in values of SBP, DBP, MAP, HR and plasma concentrations of E, NE and Cor at same time point between the two groups during operation (P>0.05). There was no statistical significance in value of BIS at T0-T5 between the two groups (P>0.05). However, value of BIS at T6 in test group was significantly higher than that in control group (69.7±2.1 vs. 58.6±2.3, P<0.01). Doses of sevoflurane, propofol sufentanil and cisatracurium used up in test group decreased by 12.3% (P<0.01); 12.7% (P<0.01); 14.5% (P<0.01) and 4.9% (P>0.05) than those in control group, respectively. Continuous endotracheal-laryngopharynx topical anesthesia using 1% Tetracaine via medicine-injecting endotracheal tube can significantly decrease general anesthetic requirements of surgery.
