脉冲射频后硬膜外自控镇痛联合超声引导周围神经阻滞治疗带状疱疹中、重度疼痛的效果

Efficacy of pulse radiofrequency epidural controlled analgesia combined with ultrasound-guided peripheral nerve block in the treatment of moderate and severe pain in herpes zoster

目的探讨中、重度疼痛的带状疱疹患者给予脉冲射频(PRF)及硬膜外自控镇痛(PCEA)后进行超声引导下周围神经阻滞能否更好减轻疼痛。方法选取2020年10月至2021年10月在厦门医学院附属第二医院疼痛科诊断为带状疱疹神经痛患者,并予以疼痛数字评分法(NRS)进行评分,选取≥4分的患者共30例,按照随机数表法分为A组及B组:A组(n=15),B组(n=15),两组患者均予以PRF后行硬膜外镇痛泵持续镇痛,A组不予以其他特殊处理,B组除上述处理外于术后3、6 d给予超声引导下周围神经阻滞。对两组患者术前、术后4、7 d及1、3个月时进行NRS评分,并比较各时间段疼痛缓解程度。结果两组患者术后各时间较术前比较NRS评分均明显降低,差异有统计学意义(P<0.05);两组患者术后4 d时NRS评分差异无统计学意义(P>0.05),但7 d及1、3个月时B组患者NRS评分均较A组低,差异有统计学意义(P<0.05);两组患者术后4、7 d疼痛缓解程度比较,差异无统计学意义(P﹥0.05),1及3个月时B组疼痛缓解程度较A组更好,差异有统计学意义(P<0.05)。结论超声引导下周围神经阻滞联合PRF及PCEA术能更好减轻中、重度带状疱疹性神经痛患者的疼痛,能更好缓解疱疹后神经痛。

Objective To investigate whether ultrasound-guided peripheral nerve block after pulsed radiofrequency(PRF)and patient-controlled epidural analgesia(PCEA)can better relieve pain in patients with moderate and severe pain of herpes zoster.Methods Patients diagnosed with herpetic neuralgia in the Department of Pain Medicine of the Second Affiliated Hospital of Xiamen Medical College from October 2020 to October 2021 were selected and scored by pain numerical rating scale(NRS).A total of 30 patients with≥4 points were selected and divided into group A and group B according to the random number table method:group A(n=15),group B(n=15).Both groups were given epidural analgesic pump for continuous analgesia after PRF,group A was not given other special treatment;In addition to the above treatment,ultrasound-guided peripheral nerve block was given in g r o u p B 3 a n d 6 d a y s a f t e r o p e r a t i o n.N R S w e r e s c o r e d b e f o r e o p e r a t i o n,4 a n d 7 d a y s a f t e r o p e r a t i o n,1 and 3 months after operation,and the degree of pain relief in each time period was compared between the two groups.Results The NRS scores of the two groups at each time after operation were significantly lower than those before operation,and the difference was statistically significant(P<0.05).There was no significant difference in NRS score between the two groups at 4 days after operation(P>0.05),but the NRS score of group B was lower than that of group A at 7 days,1 month and 3 months after operation(P<0.05).There was n o s i g n i f i c a n t d i f f e r e n c e i n t h e d e g r e e o f pain relief between the two groups at 4 and 7 days after operation(P>0.05).At 1 and 3 months,the degree of pain relief in group B was better than that in group A,and the difference was statistically significant(P<0.05).Conclusion Ultrasound-guided peripheral nerve block combined with epidural self-controlled analgesia pump after pulsed radiofrequency can effectively relieve pain in patients with moderate and severe herpeszoster,and better relieve posth erpetic neuralgia.