超声引导下臂丛神经阻滞治疗急性带状疱疹神经痛的临床研究

Clinical study of ultrasound-guided brachial plexus blockade for pain from acute herpes zoster neuralgia

目的探讨超声引导下臂丛神经阻滞治疗急性带状疱疹神经痛的临床疗效。方法将56例老年带状疱疹患者分为A组和B组,A组采用传统解剖定位法进行臂丛神经阻滞,B组采用超声引导法。所有患者均口服普瑞巴林150mg/次,2次/d。分别于治疗前、治疗后第1~6周、2个月、3个月时行VAS评分,评价疼痛程度并记录疼痛评估时普瑞巴林的服用剂量。记录疼痛完全缓解时间及PHN发生率,评估患者满意度。结果 B组疼痛时间短于A组。B组3个月后、6个月PHN发生率明显低于A组。B组3个月、6个月后患者满意度显著高于A组(P<0.05)。截止到第4周,B组有25例患者疼痛完全缓解,3例(10.7%)3个月后2例轻度疼痛,6个月时1例(3.6%)发展为PHN。A组中21例患者第6周疼痛完全缓解,余7例中度疼痛患者在6个月时其中4例疼痛自发缓解,3例发展成为疱疹后神经痛,B组普瑞巴林的用量明显低于A组。结论超声引导下臂丛神经阻滞治疗急性带状疱疹神经痛是行之有效的治疗方法。

Objective To explore clinical efficacy of ultrasound-guided brachial plexus blockade for upper limb pain from acute herpes zoster and postherpetic neuralgia.Methods Fifty-six patients were assigned to receive a brachial plexus block using either Traditional anatomical（Group A）or ultrasound-guided localization method（Group B）.All patients received pregabalin in a dose of 150 mg twice daily.Pain assessment using the visual analog scale and amount of pregabalin being taken was measured at the initial visit（basal）,weekly for 6 weeks after the procedure and after 2,3,and 6 months.The time of complete resolution of pain and incidence of PHN was reported.Each patient＇s satisfaction was evaluated.Results There was a significantly shorter duration of pain noticed in Group B.A significantly lower incidence of PHN was encountered in Group B after 3 months and 6 months.Significantly more patient satisfaction was reported in Group B after 3 and 6 months.By the fourth week,29 patients in Group B reported no pain.Two patients reported mild pain after 3 months which was resolved by the sixth month.In Group A,22 patients reported no pain by the sixth week and 8 patients reported moderate pain after 2 and 3 months;by the sixth month,4 out of those 8 patients showed spontaneous remission of pain.There was a significant reduction in the doses of pregabalin in Group B.Conclusion Ultrasound-guided brachial plexus blockade is a very effective treatment modality for acute herpes zoster of the upper limb and PHN.