Abstract：
OBJECTIVE: Ultrasound (US)-guided intercostal nerve block (ICNB) is an easier approach with a very low incidence of complications for different surgeries; nevertheless, only a few studies estimate the effect of ICNB for acute HZ. To explore the US-guided ICNB for management of herpes zoster (HZ)-related acute pain and possible prophylaxis for post-herpetic neuralgia (PHN) taking the conventional thoracic paraverteral block (TPVB) as control.
METHODS: A total of 128 patients with HZ were retrospectively stratified into antiviral treatment (AVT) plus US-guided TPVB (TPVB group), AVT plus US-guided ICNB (ICNB group) or AVT alone (control group) based on the treatment they received. HZ-related illness burden (HZ-BOI) over 30 days after inclusion as the primary endpoint was determined by a severity-by-duration composite pain assessment. Rescue analgesic requirement, health-related quality of life, PHN incidence, and adverse events were also recorded.
RESULTS: Significantly lower HZ-BOI scores within post-procedural 30 days using the area under the curve were reported with TPVB and ICNB compared with the control group: mean difference of 57.5 (p < 0.001) and 40.3 (p = 0.003). No difference was reported between TPVB and ICNB (p = 1.01). Significant greater improvements in PHN incidence, EQ-5D-3L scores, and rescue analgesic requirements were observed during follow-up favoring two trial groups, while comparable between two trial groups. No serious adverse events were observed.
CONCLUSIONS: US-guided ICNBs were as effective as TPVBs for acute HZ. The ICNB technique was an easier and time-efficient approach as opposed to conventional TPVB, which might be encouraged as a more accessible preemptive mean for preventing PHN.
METHODS: A total of 128 patients with HZ were retrospectively stratified into antiviral treatment (AVT) plus US-guided TPVB (TPVB group), AVT plus US-guided ICNB (ICNB group) or AVT alone (control group) based on the treatment they received. HZ-related illness burden (HZ-BOI) over 30 days after inclusion as the primary endpoint was determined by a severity-by-duration composite pain assessment. Rescue analgesic requirement, health-related quality of life, PHN incidence, and adverse events were also recorded.
RESULTS: Significantly lower HZ-BOI scores within post-procedural 30 days using the area under the curve were reported with TPVB and ICNB compared with the control group: mean difference of 57.5 (p < 0.001) and 40.3 (p = 0.003). No difference was reported between TPVB and ICNB (p = 1.01). Significant greater improvements in PHN incidence, EQ-5D-3L scores, and rescue analgesic requirements were observed during follow-up favoring two trial groups, while comparable between two trial groups. No serious adverse events were observed.
CONCLUSIONS: US-guided ICNBs were as effective as TPVBs for acute HZ. The ICNB technique was an easier and time-efficient approach as opposed to conventional TPVB, which might be encouraged as a more accessible preemptive mean for preventing PHN.
摘要：
目的：超声（US）引导的肋间神经阻滞（ICNB）是一种更容易的方法，对于不同的手术，并发症的发生率非常低；然而，只有少数研究估计ICNB对急性HZ的影响。探讨以常规胸段输尿管旁阻滞（TPVB）为对照，在美国指导下的ICNB治疗带状疱疹（HZ）相关急性疼痛和预防带状疱疹后神经痛（PHN）的可能方法。
方法：对128例HZ患者进行回顾性分层，分为抗病毒治疗（AVT）加美国指导的TPVB（TPVB组），AVT加US指导的ICNB（ICNB组）或单独的AVT（对照组）基于他们接受的治疗。纳入后30天内与HZ相关的疾病负担（HZ-BOI）作为主要终点，由严重程度随持续时间的复合疼痛评估确定。抢救镇痛要求，与健康相关的生活质量，PHN发病率,并记录不良事件.
结果：使用TPVB和ICNB在术后30天内使用曲线下面积，与对照组相比，HZ-BOI评分明显降低：平均差异为57.5（p<0.001）和40.3（p=0.003）。TPVB和ICNB之间没有差异（p=1.01）。PHN发病率的显著改善，EQ-5D-3L分数,随访期间观察到抢救镇痛药的需求，有利于两个试验组，而两个试验组之间具有可比性。未观察到严重不良事件。
结论：美国指导的ICNBs与TPVBs一样有效。与传统的TPVB相比，ICNB技术是一种更简单、更省时的方法，这可能会被鼓励作为一种更容易获得的预防PHN的先发制人的手段。
方法：对128例HZ患者进行回顾性分层，分为抗病毒治疗（AVT）加美国指导的TPVB（TPVB组），AVT加US指导的ICNB（ICNB组）或单独的AVT（对照组）基于他们接受的治疗。纳入后30天内与HZ相关的疾病负担（HZ-BOI）作为主要终点，由严重程度随持续时间的复合疼痛评估确定。抢救镇痛要求，与健康相关的生活质量，PHN发病率,并记录不良事件.
结果：使用TPVB和ICNB在术后30天内使用曲线下面积，与对照组相比，HZ-BOI评分明显降低：平均差异为57.5（p<0.001）和40.3（p=0.003）。TPVB和ICNB之间没有差异（p=1.01）。PHN发病率的显著改善，EQ-5D-3L分数,随访期间观察到抢救镇痛药的需求，有利于两个试验组，而两个试验组之间具有可比性。未观察到严重不良事件。
结论：美国指导的ICNBs与TPVBs一样有效。与传统的TPVB相比，ICNB技术是一种更简单、更省时的方法，这可能会被鼓励作为一种更容易获得的预防PHN的先发制人的手段。
