Effect of Single Intra-cutaneous Injection for Acute Thoracic Herpes Zoster and Incidence of Postherpetic Neuralgia.
Pain Manag Nurs
; 19(2): 186-194, 2018 04.
Article
em En
| MEDLINE
| ID: mdl-29153295
ABSTRACT
The therapeutic effect of postherpetic neuralgia (PHN) is often disappointing and challenging. The role of intra-cutaneous injection of local anesthetic and steroids in preventing PHN remains unknown. The purpose of this study was to investigate the effect of a single intra-cutaneous injection of ropivacaine plus methylprednisolone on acute thoracic herpes zoster (HZ) pain intensity and duration, eruptive duration, and PHN incidence. A total of 97 patients with acute thoracic HZ diagnosed 1-7â¯days after the onset of the rash were randomly assigned to receive either 15â¯mL of 37.5â¯mg ropivacaine plus 40â¯mg methylprednisolone (active group, nâ¯=â¯49) or 15â¯mL of saline (placebo group, nâ¯=â¯48). Over 7â¯days, all patients received 800â¯mg of acyclovir 5 times daily and 150â¯mg pregabalin twice daily. Acetaminophen was used as a rescue analgesia when visual analog scale ≥4. Pain intensity was measured with visual analog scale and the amount of analgesic taken was evaluated at the initial visit and at weeks 1, 4, 12, and 24 after the intra-cutaneous injection. The time of complete resolution of pain, time of healing of skin eruption, and incidence of PHN were reported. The active group displayed a significantly shorter duration of pain (28.4⯱â¯46.7 vs. 59.2⯱â¯65.0, respectively; pâ¯=â¯.009) and herpetic eruption (22.5⯱â¯6.8 vs. 32.6⯱â¯7.6, respectively; pâ¯<â¯.001) than the placebo group. A significantly lower incidence of PHN was encountered in the active group after 4â¯weeks (16.3% vs. 47.9%, respectively; pâ¯=â¯.001) and 12â¯weeks (10.2% vs. 29.2%, respectively; pâ¯=â¯.019). Lower incidence of PHN was noticed in the active group after 24â¯weeks; however, this was not statistically significant (6.1% vs. 18.8%, respectively; pâ¯=â¯.059). There was a significant reduction in the average and total doses of pregabalin and acetaminophen in the active group after the injection. No serious side effects were noticed during the study period. Early single intra-cutaneous injection, in combination with antiviral agents and optimal analgesics, in the course of acute thoracic HZ seems to be a simple, well-tolerated, and effective adjuvant treatment modality. It dramatically decreased pain intensity, shortened pain duration, reduced skin eruption, and reduced and may even prevent the development of PHN.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Neuralgia Pós-Herpética
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Herpes Zoster
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Analgésicos
Tipo de estudo:
Clinical_trials
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Incidence_studies
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Observational_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article