超声引导下肋间神经阻滞联合胸椎旁阻滞治疗胸背部带状疱疹后神经痛患者的疗效

Efficacy of intercostal nerve block combined with thoracic paravertebral block guided by ultrasound in the treatment of patients with postherpetic neuralgia

目的评价超声引导下肋间神经阻滞联合胸椎旁阻滞治疗胸背部带状疱疹后神经痛患者的效果。方法收集2016年1月至2018年1月湖北省第三人民医院疼痛科诊治的胸背部带状疱疹后神经痛患者45例,年龄50~75岁,性别不限。按照随机数字表法将其随机分为3组,肋间神经阻滞组(ICNB组,n=15);胸椎旁阻滞组(TPVB组,n=15);肋间神经阻滞联合胸椎旁阻滞组(IT组,n=15)。依据其带状疱疹及疼痛区域神经节段分布范围确定受累肋间神经及椎旁阻滞节段,ICNB组采用超声引导下肋角处肋间神经阻滞;TPVB组采用超声引导下胸椎旁阻滞;IT组则同时行超声引导下肋角处肋间神经阻滞及胸椎旁阻滞,阻滞方式同ICNB组与TPVB组。治疗时间为1次/5d,共治疗3次。记录治疗前1d及全部治疗完成后1周、4周、3个月、6个月时的患者VAS评分及治疗后各时点VAS≤3例数及占比情况;记录全部治疗完成后4周、6个月时患者麻木、痛觉过敏及超敏、睡眠障碍及焦虑改善情况;记录治疗期间患者肋间神经及胸椎旁阻滞不良反应如气胸、局麻药中毒等发生情况。结果与治疗前比较,3组患者治疗后VAS评分均明显降低(P<0.05);治疗后相同时点,IT组VAS评分明显低于ICNB组及TPVB组(P<0.05);治疗后1周、4周、3个月及6个月时IT组患者VAS≤3占比情况均明显高于ICNB组及TPVB组(P<0.05)。3组治疗后麻木、痛觉过敏及超敏、睡眠障碍、焦虑均有改善,且IT组效果优于ICNB组及TPVB组(P<0.05)。3组患者均未见与肋间神经及胸椎旁阻滞有关的气胸及局麻药中毒不良反应。结论超声引导下肋间神经阻滞联合胸椎旁阻滞治疗可安全、有效地治疗胸背部带状疱疹后神经痛,其效果明显优于单纯肋间神经阻滞及单纯椎旁阻滞。

Objective To investigate the efficacy of intercostal nerve block combined with thoracic paravertebral block guided by ultrasound in the treatment of patients with postherpetic neuralgia. Methods Forty-five patients with postherpetic neuralgia in thoracic and back area, from January 2016 to January 2018 in Hubei Third People's Hospital, aged 50-75 years, both sexes, were randomly divided into three groups, 15 cases in each group. The patients received intercostal nerve block, paravertebral block and intercostal nerve block combined with paravertebral block guided by ultrasound in intercostal nerve block group (ICNB group), paravertebral block group (TPVB group) and intercostal nerve block combined with paravertebral block group(IT group) respectively, 3 times in one course, with 5 days interval in all groups. VAS and the number of VAS≤3 were recorded at 1 day before the treatment, 1 week, 4 weeks, 3 months and 6 months after all the treatment respectively. The improvement rates of numbness, hyperalgesia and allergic, sleep disorder and anxiety symptoms were recorded at 4 weeks and 6 months after all the treatment. Complications such as pneumothorax, local anesthetics intoxication were recorded during the treatment. Results Compared with pre-treatment, VAS was significantly decreased after the treatment in three groups (P<0.05). At the same time point, VAS was significantly lower in IT group than that in ICNB group and TPVB group (P<0.05). The number of VAS≤3 was significantly increased in IT group than that in ICNB group and TPVB group at 1 week, 4 weeks, 3 months and 6 months after all the treatment (P<0.05). The improvement rates of numbness, hyperalgesia and allergic, sleep disorder and anxiety symptoms were significantly higher in IT group than those in ICNB group and TPVB group at 4 weeks and 6 months after all the treatment. No aerothorax and local anesthetic intoxication were found in all patients. Conclusion Ultrasound-guided intercostal nerve block combined with paravertebral block is a safe and effective method for the treatment of patients with postherpetic neuralgia, and is obviously superior to intercostal nerve block or paravertebral block alone.