Ultrasound-Guided Erector Spinae Block Versus Ultrasound-Guided Thoracic Paravertebral Block for Pain Relief in Patients With Acute Thoracic Herpes Zoster: A Randomized Controlled Trial

BACKGROUND

Severe acute pain is a significant risk factor for postherpetic neuralgia (PHN). The importance of early management in alleviating zoster pain cannot be overstated.

OBJECTIVES

This study aimed to determine the efficiency and safety of one bolus injection thoracic paravertebral block (PVB) and erector spinae plane block (ESB) in individuals with acute thoracic herpes zoster (HZ) in preventing PHN.

STUDY DESIGN

A prospective randomized controlled trial.

SETTING

Tanta University Hospitals, Tanta, Egypt.

METHODS

Ninety participants over the age of 50 years with chest wall herpetic eruption, lasting shorter than a week along with moderate to severe pain, who got adequate antiviral medication. Patients were chosen at random and classified into 3 equal groups. Group C (control group) did not receive any intervention. Group ESB received US-guided ESB with 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone (10 mL volume). Group PVB received US-guided PVB with 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone (10 mL volume).

RESULTS

Numerical rating scale (NRS) showed insignificant differences at baseline. NRS for pain at 1, 3, 4, 12, and 24 weeks was significantly reduced in group ESB compared to group C and in group PVB than group C and insignificantly different between group ESB and group PVB. Doses of pregabalin and acetaminophen were comparable at 1 week among the studied groups. Doses of pregabalin and acetaminophen at 3, 4, 12, and 24 weeks were significantly lesser in group ESB compared to group C and in group PVB than group C and insignificantly different between group ESB and group PVB. After 3 months, the incidence of persistent herpetic pain was not significantly different between the study groups. After 6 months, the incidence of persistent herpetic pain was statistically significantly lower in groups ESB and PVB than in group C (P = 0.037 and 0.015, respectively) without significant difference between group ESB and group PVB.

LIMITATIONS

Small sample size, single center study.

CONCLUSIONS

Both ESB and PVB were effective in controlling acute pain and persistent herpetic pain after 6 months (which was evident by lower NRS for pain and doses of pregabalin and acetaminophen), but ESB is safer (no reported pneumothorax and hypotension).

Comparative Study between the Effect of Perineural versus Intravascular Dexmedetomidine in Ultrasound-Guided Supraclavicular Brachial Plexus Block

Background: Augmentation of postoperative analgesia with various adjuvants has become a standard in regional anesthesia. There are no studies about dexmedetomidine multiple approaches in supraclavicular brachial plexus block (BPB) was contrasted. We compare perineural dexmedetomidine and intravenous dexmedetomidine Bupivacaine as adjuvant in supraclavicular brachial plexus block. Materials and Methods: This prospective randomized controlled double-blind study was conducted on 120 patients with age between 20 and 60 years, both sexes, scheduled for elective upper limb surgery. Patients were randomly allocated into 3 groups, 40 patients in each received plain bupivacaine 0.5% (20 ml) in supraclavicular BPB; group I (Control group): add 1 mL normal saline perineural, group II: Bupivacaine with perineural dexmedetomidine (BDP) add 1 μg.kg-1dexmedetomidine perineurally. group III: Bupivacaine with intravenous dexmedetomidine (BDV) add 0.5 μg.kg-1 dexmedetomidine in 50 mL of normal saline administered as infusion over 10 min. Onset and duration of sensory and motor blocks, hemodynamic variables, adverse effects, and duration of analgesia were assessed. Results: Heart rate and mean arterial pressure was significantly decrease in group III &group II compared to group I were compared by ANOVA (F) test. onset of sensory &motor block was statistically significant shorter in group II compared to group I & III. Duration of sensory &motor block was statistically significant longer in group II compared to group I & III. there was statistically significant decrease VAS in group II were analysed using Kruskal-Wallis test between three groups. There was statistically significant increase RSS in group II & III. The first time of analgesic request was statistically significant prolonged in duration in group II. Conclusion: Perineural dexmedetomidine (1 µg/ kg) as an adjuvant to bupivacaine is significantly high thanIV dexmedetomidine (0.5 µg/ kg) and bupivacaine alone in supraclavicular BPB as regards to the onset and the duration of sensory block, so Increasingpostoperative analgesia.