The Evaluation of Erector Spinae Plane Block for the Pain Control of Thoracic Postherpetic Neuralgia

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• Neuralgia 1,287
• Neuralgia, Postherpetic 195

Keywords

• thoracic paravertebral block
• erector spinae plane block
• thoracic postherpetic neuralgia

Neuralgia

1,287 studies on the registry are indexed under Neuralgia; 256 are open to participants now.

Lead sponsor

Yonsei University is the lead sponsor of 1,387 studies on the registry; 232 are open to participants now.

Study arms

• Experimental
  erector spinae plane block group (group E)

  ultrasound-guided erector spinae plane block

  Procedure: erector spinae plane block (20 mL of 0.25% ropivacaine with dexamethasone 5mg)

• Active comparator
  thoracic paravertebral block group (group P)

  ultrasound-guided thoracic paravertebral block

  Procedure: thoracic paravertebral block(10 mL 0.25% ropivacaine with dexamethasone 5mg)

Interventions

• Procedureerector spinae plane block (20 mL of 0.25% ropivacaine with dexamethasone 5mg)

  In group E, The patient was placed in a sitting position and a high-frequency linear ultrasound transducer was placed in a longitudinal orientation 3 cm lateral to the thoracic spinous process. Three muscles were identified superficial to the hyperechoic transverse process shadow as follows: trapezius, rhomboid major, and erector spinae. An 8-cm 22-gauge block needle was inserted in a cephalad-to-caudad direction until the tip lay in the interfascial plane between transverse process and erector spinae muscles, as evidenced by visible linear spread of fluid between erector spinae muscles and the bony acoustic shadows of the transverse process. A total of 20 mL of 0.25% ropivacaine with dexamethasone 5mg was injected here.

• Procedurethoracic paravertebral block(10 mL 0.25% ropivacaine with dexamethasone 5mg)

  2) In group P, an appropriate thoracic spinous precess is located by positioning the probe in the transverse plane. Then the probe is moved laterally to locate the transverse process. The probe is manipulated slightly caudad or cephala to locate the intercostal space. The transverse process is visualized medially with the pleura dipping under the inferolateral aspect. The internal intercostal membrane, which is contiguous with the superior costotransverse ligament, was generally seen as a thin, radiopaque line extending from the transverse process, creating a wedge-shaped pocket, which represents the thoracic paravertebral space. A 22-gauge, facet-tip needle is advanced, in plane, from the lateral aspect of the ultrasound probe. When the needle pierced the internal intercostal membrane, and after aspiration demonstrated the absence of air or blood, 10 mL 0.25% ropivacaine with dexamethasone 5mg deposited in 5-mL increments.

Primary outcomes

1. 1. Pain score (NRS)

   1. in both groups, the patient is asked to score the pain before the procedure and 4 weeks later. And then the change of pain score is recorded. * NRS(numeric rating scale, on a scale of 0 to 10, with 0 being no pain at all and 10 being the worst pain imaginable)

   Time frame: Changes of Pain score from the procedure to 4 weeks

2. 2. painDETECT score

   2. the patient is asked to painDETECT score the pain before the procedure and 4 weeks later. And then the change of painDETECT score is recorded. * painDETECT Questionnaire. The first five questions ask about the gradation of pain, scored from 0 to 5 (never = 0, hardly noticed = 1, slightly = 2; moderately = 3, strongly = 4, very strongly = 5). Question 6 asks about the pain course pattern, scored from -1 to 2, depending on which pain course pattern diagram is selected. Question 7 asks about radiating pain, answered as yes or no, and scored as 2 or 0 respectively. The total score summed each subscales is between -1 and 38, indicates the likelihood of a neuropathic pain component. A score less than 12 indicates that pain is unlikely to have a neuropathic component, while a score more than 19 suggests that pain is likely to have a neuropathic component.

   Time frame: Changes of painDETECT score from the procedure to 4 weeks

3. 3. PGIC, 7 scales(overall improvement of pain relief)

   3. the patient is asked to PGIC, 7 scales about overall improvement of pain relief 4 weeks later. * Patient's global impression of change(PGIC) scale. Since beginning treatment at this clinic, the change (if any) in ACTIVITY LIMITATIONS, SYMPTOMS, EMOTIONS, and OVERALL QUALITY OF LIFE, related to your painful condition. (No change =1, almost the same = 2, a little better = 3, somewhat better =4, moderate better =5, better =6, a great deal better =7)

   Time frame: Changes of PGIC, 7 scales from the procedure to 4 weeks

Individual participant data

Plan to share: No