Temporary Spinal Cord Stimulation for Herpes Zoster With Myelitis: A Case Series.

Introduction: Preventing the development of postherpetic neuralgia (PHN), the most prevalent and severe complication of herpes zoster (HZ), is vital. Recently, it has been suggested that using temporary spinal cord stimulation (tSCS) for 10-14 days can improve HZ-associated pain (ZAP) and prevent PHN. However, myelitis complicates HZ. Permanent SCS has been successful in treating neuropathic pain induced by postoperative transverse myelitis of the spine that has not responded to traditional multidisciplinary treatment. However, it is unknown whether tSCS can reduce ZAP complicated with myelitis. Methodology: Between January 2020 and April 2022, all patients with HZ who visited our pain clinic with spinal cord edema and who underwent tSCS were enrolled in this study; their medical records were retrospectively examined. Pain intensity was assessed at baseline (before initiating interventional procedures), just before tSCS, after tSCS removal, and one and three months after tSCS. Results: Twelve patients were enrolled. The mean Numerical Rating Scale (NRS) was 7.9 ± 1.6 at baseline (before interventional procedures), 6.8 ± 2.2 before tSCS (after interventional procedures), and 3.5 ± 2.4 after tSCS. Compared with before tSCS, the mean NRS decreased to 3.3 ± 2.3 after tSCS (P = 0.0004). The mean NRS changes with interventional procedures before and after tSCS were -1.2 ± 2.2 (P = 0.0945) and 3.3 ± 2.3 (P = 0.0004), respectively; the change after tSCS was significantly higher (between-group difference: -2.1 ± 3.7; P = 0.0324). Conclusions: Temporary SCS alleviated pain in cases of shingles with myelitis refractory to interventional therapy. Even in cases with myelitis, tSCS for ZAP remains an effective way to prevent PHN.

How to Use Pectoral Nerve Blocks Effectively­An Evidence-Based Update

Since the original description in 2011, the array of pectoral nerve blocks has evolved. The pectoral nerve (PECS) block in conjunction with general anesthesia can decrease an additional analgesic in perioperative period for breast cancer surgeries. Current literature on the PECS block has reported 3 several types (PECS I, PECS II, and serratus plane blocks). The PECS I block is the same as to the fi rst injection in the PECS II block. The second injection in the PECS II block and the serratus plane block blocks intercostal nerves (Th2­6) and provides an analgesic for the breast cancer surgery. However, the PECS I block (or fi rst injection in the PECS II block) has no analgesic, because both lateral and medial pectralis nerve blocks are motor nerves. PECS block in previous reports, when added to opioid-based general anesthesia, may improve analgesia and decrease narcotic use for breast cancer surgery. Moreover, PECS block compares favorably with other regional techniques for selected types of surgery. A major limitation of the PECS block is that it cannot block the internal mammary region. Therefore, some studies have reported its ability to block the anterior branches of the intercostal nerve. PECS block is an effective analgesic tool for the anterolateral chest. In particular, the PECS block can provide more effective analgesia for breast cancer surgery.

RETRACTED: Thoracolumbar interfascial plane block provides effective perioperative pain relief for patients undergoing lumbar spinal surgery; a prospective, randomized and double blinded trial.

STUDY OBJECTIVE: Background: Although bilateral ultrasound-guided thoracolumbar interfascial plane (TLIP) block provides effective analgesia to the lumbar spinal region, a few previous studies for the TLIP block have only been reported up to the present. We aimed to study whether the TLIP block in combination with general anesthesia would provide more effective pain relief compared to general anesthesia alone. DESIGN: Prospective randomized controlled trial. SETTING: Operation and recovery room, hospital ward. PATIENTS: Seventy-two patients undergoing primary lumbar laminoplasty of less than three levels between May 2016 and April 2017. INTERVENTIONS: Seventy-two patients undergoing primary lumbar laminoplasty of less than three levels were randomly allocated to receive either the TLIP block combined with general anesthesia (T group, n = 35) or general anesthesia alone (C group, n = 34). MEASUREMENT: The primary outcome measured the cumulative amount of fentanyl delivered to the patients through PCA within 48 h after the end of surgery. Secondary outcomes measured the number of delivered and requested PCA doses and VAS pain scores at the surgical site obtained at rest as well as with movement at specific time points within 48 h after the surgery. MAIN RESULTS: During the first 48 h after surgery, the cumulative amount of delivered fentanyl (mean [standard deviation]) (µg) was lower in the T group (198.3 [103.1]) (µg) than in the C group (452.9 [175.4]) (µg) (P < 0.001). The number of delivered and requested PCA doses and the VAS pain scores was also lower in the T group than in the C group at all time points (all data were less than P < 0.05). CONCLUSIONS: Bilateral TLIP block combined with general anesthesia provides more effective perioperative pain relief than that provided by general anesthesia alone in patients who undergo lumbar spinal surgery.