Efficacy of erector spinae plane block in pain management for patients with herpes zoster: a systematic review and meta-analysis
Eficácia do bloqueio do plano eretor da espinha no tratamento da dor em pacientes com herpes-zóster: uma revisão sistemática e meta-análise
Alexandre Yamada Fujimura Júnior, Carolina Braga Moura, Arnaldo Bastos dos Santos
Abstract
Objectives
Systematic review and meta-analysis to evaluate the efficacy of the Erector Spinae Plane Block (ESPB) in managing pain related to Herpes Zoster.
Methods
We systematically searched PubMed, Embase, Cochrane Library, and CNKI for randomized trials comparing ESPB plus standard clinical treatment with clinical treatment alone. The population included patients with acute infection and those with Postherpetic Neuralgia (PHN). The primary outcome was pain intensity, and secondary outcomes included analgesic consumption. Mean Difference (MD) was used for continuous outcomes, and Risk Ratio (RR) for binary outcomes.
Results
Seven trials with 362 patients were included. ESPB significantly reduced pain up to eight weeks (MD = -1.21; 95% CI -2.17 to -0.24; I2 = 89%). In the subgroup analysis of patients in the acute stage, the benefit seemed to extend with pain reduction lasting up to 12-weeks (MD = -1.49; 95% CI -2.61 to -0.37; I2 = 0%), and a reduction in the incidence of PHN (RR = 0.49; 95% CI 0.28 to 0.85; I2: 0%). In the PHN subgroup, pain reduction was notable only at four weeks (MD = -1.08; 95% CI -1.81 to -0.35; I2 = 86%). ESPB also reduced acetaminophen (MD = -0.6 g.day-1; 95% CI -1.05 to -0.14; I2 = 49%) and pregabalin consumption (-68.58 mg.day-1; 95% CI -127.18 to -9.97; I2 = 41%) over 12 weeks.
Conclusion
ESPB seems to provide pain relief in Herpes Zoster patients, with a prolonged benefit in the acute stage. Also, ESPB reduced the need for analgesics over 12 weeks. More research is needed to corroborate this practice.
Keywords
Resumo
Introdução
Revisão sistemática e meta-análise para avaliar a eficácia do Bloqueio do Plano Eretor da Espinha (BPEE) no tratamento da dor relacionada ao Herpes-Zóster.
Métodos
Pesquisamos sistematicamente no PubMed, Embase, Cochrane Library e CNKI por ensaios randomizados comparando BPEE mais tratamento clínico padrão com tratamento clínico isolado. A população incluiu pacientes com infecção aguda e aqueles com Neuralgia Pós-Herpética (NPH). O desfecho primário foi a intensidade da dor, e os desfechos secundários incluíram o consumo de analgésicos. A Diferença Média (DM) foi usada para desfechos contínuos, e a Razão de Risco (RR) para desfechos binários.
Resultados
Sete ensaios com 362 pacientes foram incluídos. O BPEE reduziu significativamente a dor em até oito semanas (DM = -1,21; IC de 95% -2,17 a -0,24; I2 = 89%). Na análise de subgrupo de pacientes no estágio agudo, o benefício pareceu se estender com redução da dor durando até 12 semanas (MD = -1,49; IC 95% -2,61 a -0,37; I2 = 0%), e uma redução na incidência de PHN (RR = 0,49; IC 95% 0,28 a 0,85; I2: 0%). No subgrupo PHN, a redução da dor foi notável apenas em quatro semanas (MD = -1,08; IC 95% -1,81 a -0,35; I2 = 86%). BPEE também reduziu o acetaminofeno (MD = -0,6 g.dia-1; IC de 95% -1,05 a -0,14; I2 = 49%) e o consumo de pregabalina (-68,58 mg.dia-1; IC de 95% -127,18 a -9,97; I2 = 41%) ao longo de 12 semanas.
Conclusão
BPEE parece proporcionar alívio da dor em pacientes com Herpes-Zóster, com um benefício prolongado no estágio agudo. Além disso, BPEE reduziu a necessidade de analgésicos ao longo de 12 semanas. Mais pesquisas são necessárias para corroborar essa prática.
Palavras-chave
References
1. Lim DZJ, Tey HL, Salada BMA, et al. Herpes Zoster and Post-Herpetic Neuralgia-Diagnosis, Treatment, and Vaccination Strategies. Pathog. Basel Switz. 2024;13:596.
2. John AR, Canaday DH. Herpes Zoster in the Older Adult. Infect. Dis. Clin. North Am. 2017;31:811−26.
3. Marra F, Parhar K, Huang B, Vadlamudi N. Risk Factors for Herpes Zoster Infection: A Meta-Analysis. Open Forum Infect. Dis. 2020;7:ofaa005.
4. Zhou H, Wang Z, Jin H, Chen X, Lei L. A systematic review and meta-analysis of independent risk factors for postherpetic neuralgia. Ann Palliat Med. 2021;10:12181−9.
5. Wang Q, Yang L, Li L, Liu C, Jin H, Lin L, et al. Willingness to Vaccinate Against Herpes Zoster and Its Associated Factors Across WHO Regions: Global Systematic Review and Meta-Analysis, 9. JMIR Public Health Surveill; 2023. p. e43893.
6. Katz J, Cooper EM, Walther RR, Sweeney EW, Dworkin RH. Acute pain in herpes zoster and its impact on health-related quality of life. Clin Infect Dis. 2024;39:342−8.
7. Kim HJ, Ahn HS, Lee JY, et al. Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis. Korean J Pain. 2017;30:3−17.
8. Kim J, Kim MK, Choi GJ, Shin HY, Kim BG, Kang H. Pharmacological and non-pharmacological strategies for preventing postherpetic neuralgia: a systematic review and network metaanalysis. Korean J Pain. 2021;34:509−33.
9. Wen B, Wang Y, Zhang C, Xu W, Fu Z. Efficacy of different interventions for the treatment of postherpetic neuralgia: a Bayesian network meta-analysis. J Int Med Res. 2020;48:0300060520977416.
10. Slinchenkova K, Lee K, Choudhury S, Sundarapandiyan D, Gritsenko K. A Review of the Paravertebral Block: Benefits and Complications. Curr Pain Headache Rep. 2023;27:203−8.
11. Surdhar I, Jelic T. The erector spinae plane block for acute pain management in emergency department patients with rib fractures. CJEM. 2022;24:50−4.
12. Koo C-H, Lee H-T, Na H-S, Ryu J-H, Shin H-J. Efficacy of Erector Spinae Plane Block for Analgesia in Thoracic Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2022;36:1387−95.
13. Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.
14. Rosas S, Paco M, Lemos C, Pinho T. Comparison between the ¸ Visual Analog Scale and the Numerical Rating Scale in the perception of esthetics and pain. Int Orthod. 2017;15:543−60.
15. Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or midquartile range. Stat Methods Med Res. 2018;27:1785−805.
16. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135.
17. Mood AM, Graybill FA, Boes DC. Introduction to the Theory of Statistics. New York: McGraw-Hill; 1974.
18. Snedecor GW, Cochran WG. Statistical Methods. 1989.
19. Sterne JAC, Savovic J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.
20. McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2021;12:55−61.
21. Patil A, Vyshnavi S, Raja T, Shastry V, Thammaiah SH, Archana KN. A Randomized clinical trial comparing the efficacy of ultrasound-guided erector spinae block and paravertebral block in preventing postherpetic neuralgia in patients with zoster-associated pain. J. Anaesthesiol. Clin. Pharmacol. 2024;40:510−5.
22. Lin Z-M, Wang H-F, Zhang F, Ma J-H, Yan N, Liu X-F. The Effect of Erector Spinae Plane Blockade on Prevention of Postherpetic Neuralgia in Elderly Patients: A Randomized Double-blind Placebo-controlled Trial. Pain Physician. 2021;24:E1109−18.
23. Abdelwahab EH, Hodeib AA, Marof HM, Fattooh NH, Afandy ME. Ultrasound-Guided Erector Spinae Block Versus UltrasoundGuided Thoracic Paravertebral Block for Pain Relief in Patients with Acute Thoracic Herpes Zoster: A Randomized Controlled Trial. Pain Physician. 2022;25:E977−85.
24. Ahmed SA, Magdy AA, Abdullah MA, Albadry AA. The Effect of Erector Spinae Plane Block With and Without Addition of Magnesium on Relief of Pain from Post-herpetic Neuralgia. Pain Physician. 2022;25:365−72.
25. El-Sayed MA, Zanaty O, Shafshak W, Abdelmaksoud R, Gamal Eldine H. Role of ultrasound guided erector spinae plane block in management of acute herpes zoster pain and incidence of post-herpetic neuralgia. Egypt J Anaesth. 2021;37:343−8.
26. Xiang Y, Liu F, Liu Y, Sun W. Ultrasound-guided erector spinae plane block for the treatment of postherpetic neuralgia. Chinese Journal of Pain Medicine. 2018;24:786−9.
27. Cao Y, Yue K, Zhang JX, Lin XW. Ultrasound-guided erector spinae plane block combined with pregabalin for post-herpetic neuralgia. Zhonghua Yi Xue Za Zhi. 2019;99:2907−11.
28. Patil A, Goldust M, Wollina U. Herpes zoster: A Review of Clinical Manifestations and Management. Viruses. 2022;14:192.
29. Oaklander AL. Mechanisms of pain and itch caused by herpes zoster (shingles). J. Pain. 2018;9:S10−8.
30. Tang Y, Ren C, Wang M, et al. Altered gray matter volume and functional connectivity in patients with herpes zoster and postherpetic neuralgia. Brain Res. 2021;1769:147608.
31. Liu J, Gu L, Huang Q, et al. Altered gray matter volume in patients with herpes zoster and postherpetic neuralgia. J Pain Res. 2019;12:605−16.
32. Jiang X, Kuang H, Lv H, et al. Aberrant functional and causal connectivity of the amygdala in herpes zoster and post-herpetic neuralgia patients. Br J Radiol. 2023;96:20230338.
33. Devor M. Rethinking the causes of pain in herpes zoster and postherpetic neuralgia: the ectopic pacemaker hypothesis. Pain Rep. 2018;3:e702.
34. De Oliveira GS, Castro Alves LJ, Nader A, Kendall MC, Rahangdale R, McCarthy RJ. Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks: a metaanalysis of randomized controlled trials. Pain Res Treat. 2014;2014:179029.
35. Kirkham KR, Jacot-Guillarmod A, Albrecht E. Optimal Dose of Perineural Dexamethasone to Prolong Analgesia After Brachial Plexus Blockade: A Systematic Review and Meta-analysis. Anesth Analg. 2018;126:270−9.
36. Sawangjit R, Thongphui S, Chaichompu W, Phumart P. Efficacy and Safety of Mecobalamin on Peripheral Neuropathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Altern Complement Med N Y N. 2020;26:1117−29.
37. Xu G, Zhou GS, Tang WZ, et al. Local Administration of Methylcobalamin for Subacute Ophthalmic Herpetic Neuralgia: A Randomized, Phase III Clinical Trial. Pain Pract. 2020;20:838−49.
38. Chiew AL, Gluud C, Brok J, Buckley NA. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst Rev. 2018;2:CD003328.
39. Larson AM. Acetaminophen hepatotoxicity. Clin. Liver Dis. 2007;11:525−48. vi.
40. Khawaja A, Shahab A, Hussain SA. Acetaminophen induced Steven Johnson syndrome-toxic epidermal necrolysis overlap. J Pak Med Assoc. 2012;62:524−7.
41. Coussens NP, Sittampalam GS, Jonson SG, et al. The Opioid Crisis and the Future of Addiction and Pain Therapeutics. J Pharmacol Exp Ther. 2019;371:396−408.
42. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41:621−7.
43. De Cassai A, Geraldini F, Freo U, et al. Erector Spinae Plane Block and Chronic Pain: An Updated Review and Possible Future Directions. Biology. 2023;12:1073.
Submitted date:
10/03/2024
Accepted date:
01/26/2025
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