Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Gurodong Road 148, Guro-Gu, Seoul, 08308, Republic of Korea.
BMC Anesthesiol. 2020 Jan 28;20(1):26. doi: 10.1186/s12871-020-0950-0.
Continuous epidural infusions are commonly used in clinical settings to reduce the likelihood of transition to postherpetic neuralgia via pain control. The purpose of this study was to compare the efficacy of conventional continuous epidural infusion to that of continuous epidural infusion in which the catheter is guided by electric stimulation to areas with neurological damage for the treatment of zoster-related pain and prevention of postherpetic neuralgia.
We analyzed the medical records of 114 patients in this study. The patients were divided into two groups: contrast (conventional continuous epidural infusion) and stimulation (continuous epidural infusion with epidural electric stimulation). In the contrast group, the position of the epidural catheter was confirmed using contrast medium alone, whereas in the stimulation group, the site of herpes zoster infection was identified through electric stimulation using a guidewire in the catheter. Clinical efficacy was assessed using a numerical rating scale (pain score) up to 6 months after the procedures. We compared the percentage of patients who showed complete remission (pain score less than 2 and no further medication) in each group. We also investigated whether the patients required additional interventional treatment due to insufficient pain control during the 6-month follow-up period after each procedure.
After adjusting for confounding variables, the pain score was significantly lower in the stimulation group than in the contrast group for 6 months after the procedure. After adjustment, the odds of complete remission were 1.9-times higher in the stimulation group than in the contrast group (95% confidence interval [CI]: 0.81-4.44, P = 0.14). Patients in the contrast group were significantly more likely to require other interventions within 6 months of the procedure than patients in the stimulation group (odds ratio: 3.62, 95% CI: 1.17-11.19, P = 0.03).
Epidural drug administration to specific spinal segments using electric stimulation catheters may be more helpful than conventional continuous epidural infusion for improving pain and preventing postherpetic neuralgia in the acute phase of herpes zoster.
连续硬膜外输注在临床中常用于通过疼痛控制降低带状疱疹后神经痛转变的可能性。本研究的目的是比较传统连续硬膜外输注与通过电刺激引导导管进入神经损伤区域的连续硬膜外输注在治疗带状疱疹相关疼痛和预防带状疱疹后神经痛方面的疗效。
我们分析了本研究中 114 例患者的病历。患者分为两组：对照组（传统连续硬膜外输注）和刺激组（硬膜外电刺激下连续硬膜外输注）。在对照组中，单独使用造影剂确认硬膜外导管的位置，而在刺激组中，通过导管中的导丝进行电刺激确定带状疱疹感染部位。采用数字评分量表（疼痛评分）评估术后 6 个月的临床疗效。我们比较了两组患者完全缓解（疼痛评分<2 分且无需进一步药物治疗）的比例。我们还研究了每组患者在术后 6 个月的随访期间，由于疼痛控制不足是否需要额外的介入治疗。
调整混杂变量后，刺激组患者术后 6 个月的疼痛评分显著低于对照组。调整后，刺激组完全缓解的几率是对照组的 1.9 倍（95%置信区间：0.81-4.44，P=0.14）。与刺激组相比，对照组患者在术后 6 个月内需要其他干预的可能性显著更高（比值比：3.62，95%置信区间：1.17-11.19，P=0.03）。
使用电刺激导管向特定脊柱节段给予硬膜外药物可能比传统连续硬膜外输注更有助于改善带状疱疹急性期的疼痛和预防带状疱疹后神经痛。
