scholarly journals Therapeutic Effects of Continuous Epidural Infusion of Local Anesthetics with Dexamethasone for Postherpetic Neuralgia

2020 ◽  
Author(s):  
Eun Mi Choi ◽  
Mi Hwa Chung ◽  
Joo-Hyun Jun ◽  
Eun Hee Chun ◽  
In-Jung Jun ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Complete Remission ◽  
Local Anesthetics ◽  
Pulse Therapy ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion ◽  
Steroid Administration ◽  
Vas Scores ◽  
Epidural Steroid ◽  
Dexamethasone Pulse Therapy

The most common complication of herpes zoster is postherpetic neuralgia (PHN), which is accompanied by severe pain that lowers patients’ quality of life. Although epidural injection of local anesthetics and steroids is effective in controlling neuropathic pain resulting from herpes zoster, few studies report the efficacy and safety of epidural steroid administration in PHN patients. We randomly assigned 42 patients with severe PHN pain (visual analog scale (VAS) score ≥7) to receive continuous epidural infusion of local anesthetics with either a one-time bolus of 5 mg dexamethasone or dexamethasone pulse therapy. VAS scores significantly decreased over time for all patients, but the reduction in VAS scores and likelihood of achieving complete remission were significantly greater among patients who received dexamethasone pulse therapy, without any adverse effects. These results show that continuous epidural infusion of local anesthetics with dexamethasone is effective and safe for reducing PHN pain and promoting complete remission and that more pronounced beneficial effects are associated with more intense epidural steroid administration.

scholarly journals Comparison of the Analgesic Effect of Ropivacaine with Fentanyl and Ropivacaine Alone in Continuous Epidural Infusion for Acute Herpes Zoster Management: A Retrospective Study

Medicina ◽  
2020 ◽  
Vol 56 (1) ◽  
pp. 22 ◽  
Author(s):  
Hee Yong Kang ◽  
Chung Hun Lee ◽  
Sang Sik Choi ◽  
Mi Kyoung Lee ◽  
Yeon Joo Lee ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Complete Remission ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Epidural Infusion ◽  
Complication Rates ◽  
Continuous Epidural Infusion ◽  
The Difference ◽  
Control Pain ◽  
Numeric Rating

Background and Objectives: Currently, few studies have reported the effects of opioids during continuous epidural infusion (CEI) to control pain owing to herpes zoster (HZ). This study aimed to retrospectively compare the effectiveness of epidural opioids in the treatment of acute HZ pain. Materials and Methods: We reviewed medical records of 105 patients who were divided into two groups: R group (CEI with ropivacaine) and RF group (CEI with ropivacaine and fentanyl). Clinical efficacy was evaluated using the numeric rating scale (NRS) score for 6 months after the procedures. We compared the percentage of patients with complete remission in each group. We investigated the complication rates during CEI. Results: No significant differences in the NRS scores were observed between the two groups in the 6-month period. The adjusted odds ratio (OR) for patients included in the complete remission was 0.6 times lower in the RF group than in the R group (95% confidence interval: 0.22–1.71, p = 0.35). The OR for complications during CEI was higher in the RF group than in the R group. However, the difference was not statistically significant. Conclusions: No difference was observed in the management of HZ pain and the prevention of postherpetic neuralgia between the two groups. The incidence of complications tended to be higher in the RF group than in the R group.

scholarly journals Efficacy of continuous epidural infusion with epidural electric stimulation compared to that of conventional continuous epidural infusion for acute herpes zoster management: A retrospective study

2020 ◽  
Author(s):  
Chung Hun Lee ◽  
Sang Sik Choi ◽  
Mi Kyoung Lee ◽  
Yeon Joo Lee ◽  
Jong Sun Park
Keyword(s):  
Herpes Zoster ◽  
Complete Remission ◽  
Pain Score ◽  
Postherpetic Neuralgia ◽  
Pain Control ◽  
Electric Stimulation ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion ◽  
Contrast Group ◽  
Stimulation Group

Abstract Background: Continuous epidural infusions are commonly used in clinical settings to reduce the likelihood of transition to postherpetic neuralgia via pain control. The purpose of this study was to compare the efficacy of conventional continuous epidural infusion to that of continuous epidural infusion in which the catheter is guided by electric stimulation to areas with neurological damage for the treatment of zoster-related pain and prevention of postherpetic neuralgia.Methods: We analyzed the medical records of 114 patients in this study. The patients were divided into two groups: contrast (conventional continuous epidural infusion) and stimulation (continuous epidural infusion with epidural electric stimulation). In the contrast group, the position of the epidural catheter was confirmed using contrast medium alone, whereas in the stimulation group, the site of herpes zoster infection was identified through electric stimulation using a guidewire in the catheter. Clinical efficacy was assessed using a numerical rating scale (pain score) up to 6 months after the procedures. We compared the percentage of patients who showed complete remission (pain score less than 2 and no further medication) in each group. We also investigated whether the patients required additional interventional treatment due to insufficient pain control during the 6-month follow-up period after each procedure.Results: After adjusting for confounding variables, the pain score was significantly lower in the stimulation group than in the contrast group for 6 months after the procedure. After adjustment, the odds of complete remission were 1.9-times higher in the stimulation group than in the contrast group (95% confidence interval [CI]: 0.81-4.44, P = 0.14). Patients in the contrast group were significantly more likely to require other interventions within 6 months of the procedure than patients in the stimulation group (odds ratio: 3.62, 95% CI: 1.17-11.19, P = 0.03).Conclusion: Epidural drug administration to specific spinal segments using electric stimulation catheters may be more helpful than conventional continuous epidural infusion for improving pain and preventing postherpetic neuralgia in the acute phase of herpes zoster.

scholarly journals Efficacy of continuous epidural infusion with epidural electric stimulation compared to conventional continuous epidural infusion for acute herpes zoster management: A retrospective study

2019 ◽  
Author(s):  
Chung Hun Lee ◽  
Sang Sik Choi ◽  
Mi Kyoung Lee ◽  
Yeon Joo Lee ◽  
Jong Sun Park
Keyword(s):  
Herpes Zoster ◽  
Pain Score ◽  
Postherpetic Neuralgia ◽  
Pain Control ◽  
Odds Ratio ◽  
Electric Stimulation ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion ◽  
Contrast Group ◽  
Stimulation Group

Abstract Background: A continuous epidural infusion is commonly used in clinical settings, and reduces the likelihood of transition to postherpetic neuralgia via pain control. The purpose of the present study was to compare the efficacy of conventional continuous epidural infusion to that of continuous epidural infusion where the catheter is specifically guided by electric stimulation to areas with neurological damage in the treatment of zoster-related pain and prevention of postherpetic neuralgia. Methods: We analyzed the medical records of 114 patients in the present study. The patients were divided into two groups: contrast (conventional continuous epidural infusion), and stimulation (continuous epidural infusion with epidural electric stimulation). In the contrast group, the position of the epidural catheter was confirmed using contrast medium alone, whereas in the stimulation group, the site of herpes zoster infection was identified through electric stimulation using a guidewire in the catheter. Clinical efficacy was assessed using a numerical rating scale (pain score) up to 6 months after the procedures. We compared the percentage of patients who showed complete remission (pain score less than 2, and no further medication) in each group. We also investigated whether the patients required additional interventional treatment due to insufficient pain control during the 6-month follow-up period after each procedure. Results: After adjusting for confounding variables, the pain score was significantly lower in the stimulation group than in the contrast group for 6 months after the procedure. The adjusted odds ratio of patients included in the complete remission category was 1.9 times higher in the stimulation group than in the contrast group (95% confidence interval: 0.81-4.44, P = 0.14). The adjusted odds ratio for other interventions within 6 months after the procedure was 3.62 times higher in the contrast group than in the stimulation group (95% confidence interval: 1.17-11.19, P = 0.03). Conclusion: Epidural drug administration to specific spinal segments using electric stimulation catheters may be more helpful than conventional continuous epidural infusion for improving pain and preventing postherpetic neuralgia in acute phase of herpes zoster.

scholarly journals Regression of Sensory and Motor Blockade, and Analgesia During Continuous Epidural Infusion of Ropivacaine and Fentanyl in Comparison with Other Local Anesthetics

Pain Medicine ◽  
2007 ◽  
Vol 8 (7) ◽  
pp. 546-553 ◽  
Author(s):  
Akifumi Kanai ◽  
Satoru Osawa ◽  
Asaha Suzuki ◽  
Akiko Ozawa ◽  
Hirotsugu Okamoto ◽  
...  
Keyword(s):  
Local Anesthetics ◽  
Epidural Infusion ◽  
Motor Blockade ◽  
Continuous Epidural Infusion
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