Fujimura Júnior Alexandre Yamada, Moura Carolina Braga, Santos Arnaldo Bastos Dos
Faculdade de Medicina de Marília (FAMEMA), Departamento de Medicina, Marília, SP, Brazil.
Universidade Federal Fluminense (UFF), Departamento de Neurologia, Niterói, RJ, Brazil.
Braz J Anesthesiol. 2025 Mar-Apr;75(2):844598. doi: 10.1016/j.bjane.2025.844598. Epub 2025 Feb 18.
Systematic review and meta-analysis to evaluate the efficacy of the Erector Spinae Plane Block (ESPB) in managing pain related to Herpes Zoster.
We systematically searched PubMed, Embase, Cochrane Library, and CNKI for randomized trials comparing ESPB plus standard clinical treatment with clinical treatment alone. The population included patients with acute infection and those with Postherpetic Neuralgia (PHN). The primary outcome was pain intensity, and secondary outcomes included analgesic consumption. Mean Difference (MD) was used for continuous outcomes, and Risk Ratio (RR) for binary outcomes.
Seven trials with 362 patients were included. ESPB significantly reduced pain up to eight weeks (MD = -1.21; 95% CI -2.17 to -0.24; I = 89%). In the subgroup analysis of patients in the acute stage, the benefit seemed to extend with pain reduction lasting up to 12-weeks (MD = -1.49; 95% CI -2.61 to -0.37; I = 0%), and a reduction in the incidence of PHN (RR = 0.49; 95% CI 0.28 to 0.85; I: 0%). In the PHN subgroup, pain reduction was notable only at four weeks (MD = -1.08; 95% CI -1.81 to -0.35; I = 86%). ESPB also reduced acetaminophen (MD = -0.6 g.day; 95% CI -1.05 to -0.14; I = 49%) and pregabalin consumption (-68.58 mg.day; 95% CI -127.18 to -9.97; I = 41%) over 12 weeks.
ESPB seems to provide pain relief in Herpes Zoster patients, with a prolonged benefit in the acute stage. Also, ESPB reduced the need for analgesics over 12 weeks. More research is needed to corroborate this practice.
This article was prospectively registered in PROSPERO (www.crd.york.ac.uk/prospero, CRD42024566674).
进行系统评价和荟萃分析，以评估竖脊肌平面阻滞（ESPB）在治疗带状疱疹相关疼痛中的疗效。
我们系统检索了PubMed、Embase、Cochrane图书馆和中国知网，以查找比较ESPB联合标准临床治疗与单纯临床治疗的随机试验。研究对象包括急性感染患者和带状疱疹后神经痛（PHN）患者。主要结局是疼痛强度，次要结局包括镇痛药消耗量。连续型结局采用均数差（MD），二分类结局采用风险比（RR）。
纳入7项试验，共362例患者。ESPB在长达8周的时间内显著减轻了疼痛（MD = -1.21；95%CI -2.17至-0.24；I² = 89%）。在急性期患者的亚组分析中，获益似乎持续存在，疼痛减轻可持续长达12周（MD = -1.49；95%CI -2.61至-0.37；I² = 0%），且PHN的发生率降低（RR = 0.49；95%CI 0.28至0.85；I²：0%）。在PHN亚组中，仅在4周时疼痛减轻显著（MD = -1.08；95%CI -1.81至-0.35；I² = 86%）。ESPB在12周内还减少了对乙酰氨基酚的消耗量（MD = -0.6 g/天；95%CI -1.05至-0.14；I² = 49%）和普瑞巴林的消耗量（-68.58 mg/天；95%CI -127.18至-9.97；I² = 41%）。
ESPB似乎能为带状疱疹患者缓解疼痛，在急性期有延长的获益。此外，ESPB在12周内减少了对镇痛药的需求。需要更多研究来证实这种治疗方法。
本文已在PROSPERO（www.crd.york.ac.uk/prospero，CRD42024566674）进行前瞻性注册。
