超声引导腹横肌平面阻滞治疗老年人腹壁带状疱疹性神经痛的随机对照试验

Ultrasound-guided transversus abdominis plane block for elderly herpetic neuralgia located in anterior abdominal wall: a randomized and controlled trial

摘要目的评价超声引导腹横肌平面阻滞对老年人前腹壁带状疱疹性神经痛疗效。方法拟行腹横肌平面阻滞的老年前腹壁带状疱疹性神经痛患者112例,年龄65~75岁,带状泡疹病程1个月以内。随机分为两组:单纯口服组作为对照组56例:口服加巴喷丁+西乐葆组;阻滞组56例,横肌平面阻滞,3次/周,连续治疗2周;同时口服加巴喷丁+西乐葆。两组出现爆发痛时均予以吗啡即释片10mg口服。于治疗前(T0)、治疗1周后(T1)、治疗2周后(T2)、治疗结束后1周(T3)、治疗结束后8周(T4),采用简化McGill评分评价其McGill得分和VAS疼痛评分,计算疼痛缓解度和吗啡用量。观察治疗期间和治疗后1周吗啡用量和睡眠质量。于治疗结束后8周进行镇痛疗效分级,计算治疗有效率和显效率,记录并发症的发生情况。结果VAS评分组间,同一时点比较,治疗前差异无统计学意义(t=0.419,P>0.05),治疗后阻滞组较对照组明显降低(t=17.925、19.662、12.580、13.987,均P<0.05)。McGill总分,组间同一时点比较,治疗前差异无统计学意义(t=0.544,P>0.05),治疗后阻滞组较对照组明显降低,差异有统计学意义(t=18.612、20.135、13.213、12.356,均P<0.05)。睡眠质量评分对照组,治疗前差异无统计学意义(t=0.323,P>0.05),治疗后组间比较,阻滞组较对照组明显降低,差异有统计学意义(t=7.798、9.545、10.335、16.318,均P<0.05)。吗啡消耗量,治疗前差异无统计学意义(t=1.939,P>0.05),治疗后组间比较,阻滞组较对照组明显降低,差异有统计学意义(t=22.341、16.758、17.827、15.541,均P<0.05)。操作过程中均无发生穿刺针误穿入腹腔、胸腔、内脏等或血管等。结论超声引导腹横肌平面阻滞对前腹壁带状疱疹性神经痛疗效确切,不良反应少。

Objective To evaluate the efficacy of ultrasound-guided transversus abdominis plane block for elderly herpetic neuralgia located in anterior abdominal wall. Methods A total of 112 elderly patients aged 65-75 years with less than 30 days of herpes zoster neuralgia located in anterior abdominal wall were enrolled for receiving a treatment of transversus abdominis plane block.Patients were randomly allocated into two groups: the control group(n=56)taking gabapentin and celebrex, and the observation group(n=56)receiving transversus abdominis plane block(three times per week for two weeks)as add on therapy to gabapentin and celebrex.Morphine 10 mg was ready for oral application in breakthrough pain.Pain was evaluated by McGill scores assessed by short-form of Mcgill pain questionnaire(SF-M PQ)and visual analogue scale(VAS)before(T0)and after 1(T1)and 2 weeks(T2)of transversus abdominis plane block, and 1(T3)and 8(T4)weeks after end of the treatment.Pain relief(PAR)was calculated by the formula: PAR=(VAS score before block--VAS score after block)/ VAS score before block × 100%.The morphine consumption and sleep quality were observed during the treatment and 1 week after treatment.Analgesic efficacy was graded 8 weeks after end of treatment.The effective rate and good response rate were calculated.Incidences of complications were recorded. Results There was no significant difference in the VAS score between the two groups before treatment(t=0.419, P>0.05), while VAS scores after treatment were lower in the observation group than in the control group(t=17.925, 19.662, 12.580 and 13.987, respectively, P<0.05). Before treatment, there was no significant difference in the total score of McGill between the two groups(t=0.544, P>0.05). After treatment, the total scores of McGill were lower in the observation group than in the control group(t=18.612, 20.135, 13.213 and 12.356, respectively, P<0.05). The pre-therapy scores of sleep quality after treatment were decreased in the observation group as compared with the control group(t=7.798, 9.545, 10.335 and 16.318, respectively, P<0.05). Before treatment and at different time points of T1, T2, T3, T4, the morphine consumptions were not significant different between two groups(t=1.939, P>0.05). While after treatment, the morphine consumptions were decreased in the observation group versus in the control group(t=22.341, 16.758, 17.827, 15.541 respectively, P<0.05). No punctures of abdominal cavity, chest cavity, internal organs or blood vessels by mistake occurred. Conclusions Ultrasound-guided transversus abdominis plane block is effective and has less adverse reactions in treating herpetic neuralgia located in anterior abdominal wall.