| Objective:To research the clinical efficacy and safety with CT-guided paravertebral injection of adriamycin+compound betamethasone or Neurotropin+ mecobalamine+compound betamethasone for the treatment of early postherpetic neuralgia.At the same time,to compare the clinical efficacy of different regimens.Methods:Collecting 56 patients diagnosed early postherpetic neuralgia in chest and back in pain department of The Secongd Hospital of Tianjin Medical University from January 2013 to December 2014.All patients viscera function usual, not gave glucocorticoid hormoneswithin a month before the treatment.56 patients were assigned to Group A to receive paravertebral injection of adriamycin+compound betamethasone, or to Group B to receive paravertebral injection of Neurotropin+mecobalamine+ compound betamethasone.After entering the operating theater, the patient was asked to lie in a lateral position with healthy side downwards, established venous pathway and monitored.Then 3-5 segments were selected according to the painful positions and the corresponding spinous process was remarked. After local anesthesia of the patients, the puncture needle(Type: 22G) was punctured by the center line to open about 5 to 6 cm, with 30 ~ 45 ° needle to the spine center line.With CT guided,the puncture needle arrived at the target point and then gas injection had no resistance and no blood or cerebros pinal fluid(CSF)was sucked out, and 1% lidocaine 2ml(testing dose) was injected subsequently, after 15 min observation, if no adverse reaction,0.33% adriamycin 3m L each segment 1m L + 2m L of compound betamethasone diluted to 3m L each segment 1m L was injected in group A; Neurotropin 3.6 IU 6m L + compound betamethasone 2m L +mecobalamine 2m L + 0.9% saline 2m L, each segment to give 4m L in group B. Keep position 6h.VAS score and SIS score were assessed for the patients preoperatively(T0), and at 1 week(T1), 1 month(T2), 3 months(T3), and 6 months(T4) postoperatively, and the pre- and post-operative adverse reactions were recorded.Results:1 General condition resultsFor the age,sex and course, two groups have no statistical significance.(P > 0.05)2 Pre-operative scores resultsScores of goup A are 7.77±1.57 and 6.08±1.50. Scores of goup B are 7.24±1.21 and 5.69±1.34.Pre-operative scores of two groups have no statistical significance.(P > 0.05)3 post-operative scores results3.1 post-operative VAS resultsPost-operative VAS of group A are 6.92±1.30,3.79±0.75,2.76±1.44 and 1.53±1.20 in diffirent points,compared with pre-operative scores have statistically significance(P<0.01).Post-operative VAS of group B are 6.57± 1.20,3.66±0.57,2.18±0.98 and 1.27±0.91 in diffirent points, compared with pre-operative scores have statistically significance(P<0.01).Post-operative VAS of two groups have no statistical significance in diffirent points.(P>0.05)3.2 post-operative SIS resultsPost-operative SISof group A are 5.84±1.40,3.24±0.83,2.84±1.55,1.60±1.11 in diffirent points, compared with pre-operative scores have statistically significance(P<0.01).Post-operative SIS of group B are 5.75±1.38,3.21±0.74,2.17±1.02,1.36±0.96 in diffirent points, compared with pre-operative scores have statistically significance(P<0.01).Post-operative SIS of two groups have statistical significance in diffirent points.(P<0.01)4 efficiency in different points resultsThe efficiency of group A in diffirent points are 89%,87%,82% and 75%, the efficiency of group B in diffirent points are 90%,89%,80% and 76%.The efficiency of two groups of two groups have no statistical significance in diffirent points.(P>0.05)5 adverse reactionAll patients had no pneumothorax,, movement disorders, spinal cord injury and other serious complications.Conclusion:CT-guided paravertebral injection of both adriamycin+compound betamethasone and Neurotropin+mecobalamine+compound betamethasone produced good safety and efficacy for the treatment of early postherpetic neuralgia, resulting in significant alleviation of herpetic pain and improvement of sleep quality in the patients. |
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