Yu Qingwen, Wu Jianxiong, Peng Shuangchun, Huang Changyan
Department of Pain, Leshan Hospital of Traditional Chinese Medicine, Leshan, China.
J Coll Physicians Surg Pak. 2025 Aug;35(8):958-963. doi: 10.29271/jcpsp.2025.08.958.
To investigate the efficacy of hydromorphone combined with dexmedetomidine with patient-controlled intravenous analgesia (PCIA) in treating patients with acute herpes zoster (HZ) neuralgia.
Randomised controlled trial. Place and Duration of the Study: Department of Pain, Leshan Hospital of Traditional Chinese Medicine, Leshan, China, from May 2023 to April 2024.
The patients diagnosed with acute HZ were randomly divided into two groups: The hydromorphone combined dexmedetomidine PCIA treatment group (Group H) and the oral tramadol control group (Group C). Both groups were given oral pregabalin and vitamin B1. Repeated measures analysis of variance, Chi-square test or Fisher's exact probability test, was used to compare the pain numeric rating scales (NRS) and the Pittsburgh sleep quality index (PSQI) of the two groups before and after 1, 4, and 12 weeks treatment (T0, T3, T4, and T5). The number of people experiencing HZ-related pain was at T4 and T5, with the levels of cluster of differentiation 4 (CD4+), 8 (CD8+), and CD4+ / CD8+ before treatment, 24 hours, and 48 hours after treatment (T0, T1, T2), respectively. And the related adverse effects were also monitored.
NRS and PSQI decreased significantly in both groups after treatment. Compared to Group C, Group H showed a significant decrease in NRS scores at T3 and T4 (p <0.001); the difference between the two groups remained statistically significant (p = 0.003) at T5. PSQI scores in Group H were lower than those in Group C after treatment (p <0.001). The frequency of HZ-related pain in Group H was also significantly lower compared to Group C (p <0.05). CD8+ levels in Group H were significantly lower than in Group C at T1 and T2 (p <0.001), which CD4+ / CD8+ levels were significantly higher than those in Group C (p <0.001). The frequency of drowsiness in Group H was higher than that in Group C (p <0.05). However, there were no significant difference between the two groups (p >0.05) in other adverse reactions, such as dizziness, nausea, and vomiting.
Hydromorphone combined with dexmedetomidine PCIA is effective in relieving HZ-related pain, and reducing the occurrence of postherpetic neuralgia (PHN). It shows a good therapeutic effect, a high safety profile, and an easy clinical application.
Patient-controlled analgesia, Hydromorphone, Dexmedetomidine, Acute herpes zoster neuralgia, Oral tramadol.
探讨氢吗啡酮联合右美托咪定行患者自控静脉镇痛（PCIA）治疗急性带状疱疹（HZ）神经痛患者的疗效。
随机对照试验。研究地点和时间：中国乐山中医医院疼痛科，2023年5月至2024年4月。
将确诊为急性HZ的患者随机分为两组：氢吗啡酮联合右美托咪定PCIA治疗组（H组）和口服曲马多对照组（C组）。两组均给予口服普瑞巴林和维生素B1。采用重复测量方差分析、卡方检验或Fisher精确概率检验，比较两组在治疗1、4和12周（T0、T3、T4和T5）前后的疼痛数字评分量表（NRS）和匹兹堡睡眠质量指数（PSQI）。记录T4和T5时发生HZ相关疼痛的人数，以及治疗前、治疗后24小时和48小时（T0、T1、T2）的分化簇4（CD4+）、8（CD8+）和CD4+/CD8+水平。并监测相关不良反应。
两组治疗后NRS和PSQI均显著降低。与C组相比，H组在T3和T4时NRS评分显著降低（p<0.001）；T5时两组间差异仍具有统计学意义（p = 0.003）。治疗后H组的PSQI评分低于C组（p<0.001）。H组HZ相关疼痛的发生率也显著低于C组（p<0.05）。H组在T1和T2时的CD8+水平显著低于C组（p<0.001），而CD4+/CD8+水平显著高于C组（p<0.001）。H组嗜睡的发生率高于C组（p<0.05）。然而，两组在头晕、恶心和呕吐等其他不良反应方面无显著差异（p>0.05）。
氢吗啡酮联合右美托咪定PCIA能有效缓解HZ相关疼痛，减少带状疱疹后神经痛（PHN）的发生。其显示出良好的治疗效果、较高的安全性和易于临床应用。
患者自控镇痛；氢吗啡酮；右美托咪定；急性带状疱疹神经痛；口服曲马多
