Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Pain Pract. 2012 Nov;12(8):595-601. doi: 10.1111/j.1533-2500.2012.00548.x. Epub 2012 Apr 3.
Differential thoracic epidural regional block, also known as a differential neural block (DNB), involves the placement of an epidural catheter placed in the thoracic epidural space to achieve appropriate anesthesia in a dermatomal distribution. This is a retrospective case series evaluating how well a DNB may predict success of subsequent visceral blockade in patients with chronic abdominal pain of visceral origin.
Of 402 patients who had a DNB performed for unexplained abdominal pain from January 2000 to January 2009, 81 patients were found to have results consistent with visceral pain and thus underwent subsequent visceral blockade. Basic demographic data, years of chronic pain, history of psychosocial issues, initial visual analog scale (VAS) pain score, pain location, and medication usage were documented in our electronic medical record database. Parameters regarding DNB and visceral blocks also were documented. Descriptive statistics were computed for all variables. The positive predictive value (PPV) for DNB for whom visceral block was successful (at least a 50% reduction in VAS) was calculated. Additionally, subjects with successful visceral blocks were compared to those with unsuccessful visceral blocks.
All patients with chronic abdominal pain with normal gastrointestinal studies who underwent DNB.
Tertiary Outpatient Pain Management Clinic.
Retrospective Cohort Study.
Mean age of patients was 46 (± 15) years, 73% were female, and median duration of pain was 5 years. 67% of subjects were taking opioid analgesics. PPV of DNB was 70.4%. Only factor found to be statistically significant with visceral block success was baseline VAS with higher scores associated with DNB predictive success (6.8 ± 1.7 vs. 5.5, 1.8; P = 0.004). Use of membrane stabilizing medications was significantly more common in subjects for whom visceral block was not successful (46% vs. 25%; P = 0.058). Area underneath curve (AUC) for VAS was found to be 0.70 (95% CI: 0.57, 0.82), which signifies fair discrimination.
Differential neural block is fairly predictive of subsequent visceral block success in patients with chronic abdominal pain of visceral origin. An initial VAS ≥ 5 provides a sensitivity of 93%, which implies that VAS < 5 may predict unsuccessful visceral block. Contrarily, a value of ≥ 8 would provide a specificity of 92% and may be used to predict success of subsequent visceral block.
差异性胸段硬膜外区域阻滞，也称为差异性神经阻滞（DNB），涉及将硬膜外导管放置在胸段硬膜外腔中，以实现特定皮节分布的适当麻醉。这是一项回顾性病例系列研究，旨在评估 DNB 在因内脏源性慢性腹痛而接受治疗的患者中，对于后续内脏阻滞成功的预测效果。
本研究共纳入了 402 例因不明原因腹痛而接受 DNB 治疗的患者，其中 81 例患者被发现存在内脏痛的结果，因此接受了后续的内脏阻滞治疗。我们的电子病历数据库中记录了基本人口统计学数据、慢性疼痛年数、精神社会问题史、初始视觉模拟量表（VAS）疼痛评分、疼痛部位和药物使用情况。DNB 和内脏阻滞的相关参数也进行了记录。对所有变量进行了描述性统计。计算了 DNB 阳性预测值（PPV），即内脏阻滞成功（VAS 至少降低 50%）的预测值。此外，还比较了内脏阻滞成功的患者与内脏阻滞失败的患者。
所有因慢性腹痛且胃肠道检查正常而接受 DNB 治疗的患者。
三级门诊疼痛管理诊所。
回顾性队列研究。
患者的平均年龄为 46（±15）岁，73%为女性，疼痛持续时间中位数为 5 年。67%的患者正在服用阿片类镇痛药。DNB 的 PPV 为 70.4%。与内脏阻滞成功相关的唯一统计学显著因素是基线 VAS，较高的 VAS 评分与 DNB 预测成功相关（6.8±1.7 与 5.5，1.8；P=0.004）。未成功进行内脏阻滞的患者中，使用膜稳定剂的比例显著更高（46% 与 25%；P=0.058）。VAS 的曲线下面积（AUC）为 0.70（95%CI：0.57，0.82），表明中等的区分度。
差异性神经阻滞对于因内脏源性慢性腹痛而接受治疗的患者后续内脏阻滞的成功具有中等的预测效果。初始 VAS≥5 可提供 93%的敏感性，这意味着 VAS<5 可能预示着内脏阻滞不成功。相反，VAS≥8 可提供 92%的特异性，可用于预测后续内脏阻滞的成功。
