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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
90
Patients will receive ultrasound-guided midpoint transverse process to pleura block using 10 mL 0.25% bupivacaine + 40 mg methylprednisolone.
Patients will receive ultrasound -guided erector spinae plane block using 10 mL 0.25% bupivacaine + 40 mg methylprednisolone.
Tanta University
Tanta, El-Gharbia, Egypt
RECRUITINGIncidence of post-herpatic neuralgia
Incidence of post-herpatic neuralgia will be recorded after 12 weeks of block
Time frame: After 12 weeks of block
Blood pressure
Blood pressure will be recoded at time of block and following up at first 24 hours.
Time frame: 24 hours postoperatively
Heart rate
Heart rate will be recoded at time of block and following up at first 24 hours.
Time frame: 24 hours postoperatively
Oxygen saturation
Oxygen saturation will be recoded at time of block and following up at first 24 hours.
Time frame: 24 hours postoperatively
Time to first rescue analgesia
Time to first rescue analgesia will be recorded from the end of surgery till first dose of Acetaminophen administrated.
Time frame: 24 hours postoperatively
Total rescue analgesics consumption
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.
Time frame: 24 hours postoperatively
Degree of pain
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
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Time frame: 12 weeks postoperatively
Total anti-convulsant drugs
Total anti-convulsant drugs will be recorded at at 24 hours, 1 week, 2 weeks, 4 weeks, 8 weeks and 12 weeks postoperatively
Time frame: 12 weeks postoperatively
Assessment of sleep quality
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.
Time frame: 12 weeks postoperatively
Incidence of complications
Incidence of complications such as pneumothorax, local anesthetic systemic toxicity, epidural spread, pleural puncture, and block failure will be recorded.
Time frame: 24 hours postoperatively