[Dose-response relationship of ropivacaine for epidural block in early herpes zoster guided by CT].

Objective: To determine the dose-response relationship of ropivacaine for epidural block in early herpes zoster by CT guided. Methods: From January 2015 to February 2017, according to the principle of completely random digital table, 80 patients with early herpes zoster who were prepared for epidural block were divided into 4 groups(each group 20 patients): in group A the concentration of ropivacaine was 0.08%, in group B was 0.10%, in group C was 0.12% and in group D was 0.14%.Under CT guidance, epidural puncture was performed in the relevant section, mixing liquid 5.0 ml (with 10% iodohydrin)were injected into epidural gap.CT scan showed that the mixing liquid covered the relevant spinal nerve segmental.The numeric rating scale(NRS) values before treatment and at 30 minutes, the incidence of adverse reactions were recorded, and the treatment were evaluated. The response to ropivacaine for epidural block in early herpes zoster was defined as positive when the NRS values was less than or equal to one.The ED(50), ED(95) and 95% confidence interval (CI) of ropivacaine for epidural block in early herpes zoster guided by CT were calculated by probit analysis. Results: The NRS values before treatment were 5.00(4.00, 6.00), 5.00(4.25, 6.00), 5.50(5.00, 6.00) and 5.00(4.00, 6.00), the difference was no significant(Z=2.576, P=0.462). The NRS values at 30 minutes decreased and the effective rate of the treatment increased(χ(2)=8.371, P=0.004), following ropivacaine dose gradient increasing, they were 1.50(1.00, 2.00), 1.00(1.00, 2.00), 0.50(0.00, 1.00) and 0.00(0.00, 1.00), the difference was statistically significant (Z=17.421, P=0.001). There was one case in group C and four cases in group D were hypoesthesia, others were no significant adverse reactions occurred. The ED(50) and ED(95) (95%CI) of ropivacaine for epidural block in early herpes zoster guided by CT were 0.078%(0.015%-0.095%)and 0.157%(0.133%-0.271%), respectively. Conclusion: Ropivacaine for epidural block in early herpes zoster guided by CT is effective for neuropathic pain, with no significant adverse reactions.目的： 观察CT引导下罗哌卡因硬膜外阻滞治疗早期带状疱疹性神经根炎的效果。 方法： 选取2015年1月至2017年2月在嘉兴市第一医院初次行CT引导下罗哌卡因硬膜外阻滞治疗早期带状疱疹性神经根炎的患者80例，病程3个月以内。采用随机数字表法分为4组(n＝20)：A组罗哌卡因浓度为0.08%、B组罗哌卡因浓度为0.10%、C组罗哌卡因浓度为0.12%、D组罗哌卡因浓度为0.14%。在CT引导下在适当节段行硬膜外穿刺置管术，置管成功后，向导管内注入含10%碘海醇的不同浓度罗哌卡因注射液共5 ml，CT扫描显示药液覆盖病变神经节段。观察并记录术前及术后30 min的疼痛数字评分法(NRS)评分、相关区域有无麻木感，并观察是否出现胸闷、低血压、心律异常等并发症，及时对症处理。镇痛有效标准：NRS评分≤1分。采用probit概率单位法计算CT引导下罗哌卡因硬膜外阻滞治疗早期带状疱疹性神经根炎镇痛有效率的半数有效剂量(ED(50))、95%有效剂量(ED(95))及95%可信区间(CI)。 结果： 4组患者术前NRS评分分别为5.00(4.00，6.00)、5.00(4.25，6.00)、5.50(5.00，6.00)和5.00(4.00，6.00)分，差异无统计学意义(Z＝2.576，P＝0.462)，随着药物浓度逐渐增加，术后NRS评分逐渐降低，分别为1.50(1.00，2.00)、1.00(1.00，2.00)、0.50(0.00，1.00)和0.00(0.00，1.00)分，差异有统计学意义(Z＝17.421，P＝0.001)。4组患者镇痛有效率随药物浓度增加而增加(χ(2)＝8.371，P＝0.004)，仅C组1例和D组4例出现术后相关区域麻木感，4组患者均未出现明显不良反应。CT引导下罗哌卡因硬膜外阻滞治疗早期带状疱疹性神经根炎镇痛有效率的ED(50)(95% CI)为0.078%(0.015%～0.095%)，ED(95)(95% CI)为0.157%(0.133%～0.271%)。 结论： CT引导下硬膜外罗哌卡因阻滞治疗早期带状疱疹性神经根炎镇痛效果确切，无明显不良反应。.