Emergency Department, Highland Hospital, Alameda Health System, 1411 E. 31st Street, Oakland, CA 94602, USA.
University of California School of Medicine, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
Am J Emerg Med. 2023 Sep;71:250.e5-250.e8. doi: 10.1016/j.ajem.2023.05.014. Epub 2023 May 23.
Patients presenting with herpes zoster (HZ) to emergency departments (EDs) across the United States represent a significant number of visits and have pain that is difficult to manage, sometimes even requiring opioid medications for adequate analgesia. Ultrasound-guided nerve blocks (UGNBs) are becoming more integrated into the ED physician's tool box for a multimodal approach to analgesia in various indications. Here we describe a novel use of the transgluteal sciatic UGNB for treatment of HZ pain along the S1 dermatome. A 48-year-old woman presented to the ED with right-sided leg pain associated with a HZ rash. After initially failing non-opioid pain management, the ED physician performed a transgluteal sciatic UGNB for our patient, leading to successful complete resolution of her pain, with no adverse effects reported. Our case highlights the potential role of using the transgluteal sciatic UGNB for analgesia related to HZ-related pain, as well as its potential opioid-sparing benefits. Although UGNBs require a baseline understanding of ultrasound technique for procedural guidance, this skillset has recently been incorporated as core competency within emergency medicine training in the United States. UGNBs should therefore be considered in the multimodal analgesic armamentarium for the ED treatment of HZ pain.
在美国，急诊部（ED）就诊的带状疱疹（HZ）患者数量众多，他们的疼痛难以控制，有时甚至需要使用阿片类药物来进行充分的镇痛。超声引导下的神经阻滞（UGNB）越来越多地被整合到 ED 医生的治疗工具箱中，成为各种适应症下多模式镇痛的方法。在这里，我们描述了一种新的经臀坐骨 UGNB 用于治疗 S1 皮节 HZ 疼痛的方法。一名 48 岁女性因右侧腿部疼痛和 HZ 皮疹到 ED 就诊。在最初非阿片类药物疼痛管理失败后，ED 医生为我们的患者进行了经臀坐骨 UGNB，成功完全缓解了她的疼痛，没有报告任何不良反应。我们的病例强调了使用经臀坐骨 UGNB 进行与 HZ 相关疼痛相关镇痛的潜在作用，以及其可能的减少阿片类药物使用的益处。尽管 UGNB 需要对超声技术有基本的了解才能进行操作指导，但这一技能在美国的急诊医学培训中已被纳入核心能力。因此，在 ED 治疗 HZ 疼痛的多模式镇痛方案中，应考虑使用 UGNB。
