Acute Herpes Zoster, Erector Spinae Plane Block, Midpoint Transverse Process to Pleura Block, Pain
Conditions
Brief summary
The aim of this study is to compare the analgesic efficacy and safety of ultrasound-guided midpoint transverse process block versus ultrasound-guided erector spinae plane block in patients suffering from thoracic herpes zoster pain.
Detailed description
Herpes zoster is caused by reactivation of latent varicella-zoster virus in dorsal root or cranial nerve ganglia and commonly presents with unilateral dermatomal rash associated with severe neuropathic pain. The erector spinae plane block is an ultrasound-guided interfascial plane block in which local anesthetic is deposited deep to the erector spinae muscle adjacent to the transverse process, allowing multidermatomal spread and thoracic analgesia. Recent studies support its efficacy in herpes zoster pain management. The midpoint transverse process to pleura block is a paravertebral-by-proxy technique where local anesthetic is injected midway between the posterior border of the transverse process and pleura. It may provide thoracic segmental analgesia with lower pleural puncture risk and easier sonoanatomy.
Interventions
Patients will receive ultrasound-guided midpoint transverse process to pleura block using 10 mL 0.25% bupivacaine + 40 mg methylprednisolone.
OTHERErector spinae plane block
Patients will receive ultrasound -guided erector spinae plane block using 10 mL 0.25% bupivacaine + 40 mg methylprednisolone.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Age 21-60 years. * Both sexes. * American Society of Anesthesiologists (ASA) physical status I-II. * Acute thoracic herpes zoster within 30 days of rash onset. * Moderate to severe pain \[numeric rating scale (NRS)≥4\].
Exclusion criteria
* Refusal to participate. * Coagulopathy or anticoagulant therapy. * Infection at puncture site. * Allergy to study drugs. * Severe psychiatric illness or inability to assess pain. * Previous thoracic surgery deformity. * Uncontrolled Diabetic patient. * Chronic diseases as renal, hepatic, malignancy. * Patients with chronic disease need analgesia. * Patients are coming for more than 3 months (after healing of rash).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of post-herpatic neuralgia | After 12 weeks of block | Incidence of post-herpatic neuralgia will be recorded after 12 weeks of block |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Blood pressure | 24 hours postoperatively | Blood pressure will be recoded at time of block and following up at first 24 hours. |
| Heart rate | 24 hours postoperatively | Heart rate will be recoded at time of block and following up at first 24 hours. |
| Oxygen saturation | 24 hours postoperatively | Oxygen saturation will be recoded at time of block and following up at first 24 hours. |
| Time to first rescue analgesia | 24 hours postoperatively | Time to first rescue analgesia will be recorded from the end of surgery till first dose of Acetaminophen administrated. |
| Total rescue analgesics consumption | 24 hours postoperatively | Acetaminophen was offered on request as a rescue analgesic at a dosage of 1,000 mg. A maximum daily dosage of 4,000 mg will be permitted for people with Numerical Rating Scale (NRS)≥ 4. |
| Degree of pain | 12 weeks postoperatively | Pain intensity will be assessed using the Numerical Rating Scale (NRS), where 0 indicates no pain and 10 indicates the worst imaginable pain. NRS will be recorded at 30 minutes, 2 hours, 6 hours, 12 hours, 24 hours, after first 24 hours, 1 week, 2 weeks, 4 weeks, 8 weeks, and 12 weeks postoperatively |
| Total anti-convulsant drugs | 12 weeks postoperatively | Total anti-convulsant drugs will be recorded at at 24 hours, 1 week, 2 weeks, 4 weeks, 8 weeks and 12 weeks postoperatively |
| Assessment of sleep quality | 12 weeks postoperatively | The Pittsburgh Sleep Quality Index (PSQI) is a 19-item self-report questionnaire will be used to assess the sleep quality. It evaluates seven clinical components: subjective sleep quality, sleep latency, duration, efficiency, disturbances, medication use, and daytime dysfunction. Each of the 7 components is scored on a scale from 0 to 3, where 0 indicates no difficulty and 3 indicates severe difficulty. Subjective Sleep Quality (Self-rated overall quality) Sleep Latency (Time it takes to fall asleep) Sleep Duration (Total hours slept per night) Habitual Sleep Efficiency (Percentage of time in bed spent asleep) Sleep Disturbances (Nighttime awakenings, breathing issues, etc.) Use of Sleeping Medication (Frequency of sleep aids) Daytime Dysfunction (Trouble staying awake or lack of enthusiasm during the day) ≤ 5: Indicates good sleep quality. \> 5: Indicates poor sleep quality. |
| Incidence of complications | 24 hours postoperatively | Incidence of complications such as pneumothorax, local anesthetic systemic toxicity, epidural spread, pleural puncture, and block failure will be recorded. |
Countries
Egypt
Contacts
CONTACTMohamed A Kazamel, MBBCH
Outcome results
None listed