Nerve block for pain therapy in herpes zoster
[Keywords:] nerve block treatment of shingles pain
Shingles is caused by a nerve tropism of varicella - zoster
virus caused. Primary infection was manifested as chickenpox or latent infection, after the virus enters the skin sensory nerve endings, and lasting latent in dorsal root ganglia section of neurons induced by stimulation in a variety of recurrent and often severe pain, rash misdiagnosed as other diseases before. neuralgia in elderly patients particularly, can be stubborn nerve pain left, continuing for several months or longer, seriously affecting patients live and work. At the moment, drug treatment is ineffective, hospital neurology clinic with nerve block therapy, to achieve better results.
1 Clinical data
1.1 General Information
A total of 40 cases of herpes zoster patients, 22 males and 18 females; age of 51 to 76 years, mean 64.7 years; course of 1 to 15 days; lesion distribution: the head and face, neck,
upper limb in 8 cases, chest, back 15 cases, waist, abdomen 7 cases, buttocks, lower extremities in 5 cases. randomly divided into A, B groups, A conventional oral analgesic treatment group, B group was treated with nerve block. pain assessment are conducted before treatment, the use of visual analogue scale (VAS). pain score scale 10cm long. ends marked from 0 to 10, 0 for no pain, 10 on behalf of pain, pain in the location marked by the patients themselves, said the pain. therapeutic evaluation: comparing pain scores before and after
treatment (in 2 weeks only), spontaneous pain, pain> 1 month for the residual pain.
In the basis of conventional antiviral therapy to intravenous infusion of acyclovir 0.25g 2 times / d, 7 days a
course of treatment. A group was treated with Fenbid 300mg, 2 times / dB groups according to different parts of rash, select the appropriate involvement of nerve as the goal-line nerve
block therapy, spinal nerve block can be used, intervertebral foramen, the body nerves, peripheral nerves, sympathetic and so on. drugs: 0.5% lidocaine, vitamin B12 500??g, mixture of 5 ~ 10ml, no contraindication to hormone dexamethasone 2.5 ~ 5mg, treatment of spinal 1 / 5d, the other block every other day 1.
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Using visual analogue scale score: Before treatment, group A 6.87 + -0.17, B group 7.01 + -0.11 after the treatment A group
4.78 + -0.14, B group 1.07 + - 0.09. The two groups before
treatment, no significant difference in pain scores between
(P> 0.05). A group of pain score decreased after treatment was not significant. B group compared with before treatment, the difference was significant (P <0.01). A group of 6 cases of residual pain, B group had no residual pain.
Varicella - zoster virus with pro-nerve, nerve pathological
changes involved said: After spinal nerve root and dorsal root ganglia with severe inflammatory reaction, single peripheral neuritis, segmental spinal cord dorsal root unilateral gray
matter inflammation, skin rash at the degeneration of sensory nerve fibers within the dermis. These violations ganglia lesions to inflammation and necrosis, resulting in significant neuralgia, pain in the rash usually appears 4 to 5 days before the start or rash became clear from 1 to 4 days [1 ]. study found that time and the aftermath of neuropathic pain, the occurrence of viral antibody titers associated with high viral titers may be the formation of immune complex levels, which stimulate the immune system and cause local nerve damage. it is key to the treatment is to inhibit viral antibody . nerve block can also directly block the sympathetic pain, improve blood circulation lesions is conducive to wound healing. The method is effective, timely and effective prevention and
control of postherpetic neuralgia. should be that in the early stages of disease accept the nerve block therapy combined with conventional therapy, the disease limits the receipt of
satisfactory results . with nerve block therapy in the
prevention of postherpetic neuralgia can have a positive effect, according to these clinical observations, proposed strip nerve block in patients with herpes can be treated with good results, should be widely applied.
[References] 1 Zhao identified. Clinical Dermatology.
Nanjing: Jiangsu Science and Technology Press, 1992,253. 2 Li Zhonglian. Clinical Pain Therapy (Revised Edition). Tianjin: Tianjin Science and Technology Press, 2002,331.
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