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Compared with nerve pulsed radiofrequency alone, the combination of intravenous lidocaine infusion and nerve pulse radiofrequency is beneficial for management of herpes zoster neuralgia pain.
An observational study depicted that intravenous lidocaine infusion coupled with digital subtraction angiography (DSA)-guided nerve pulse radiofrequency surgery ameliorates quality of life and sleep, mitigates pain, reduces the incidence rate of postherpetic neuralgia, and decreases analgesic intake in people with herpes zoster neuralgia. Wanyun Zhang et al. aimed to comprehensively assess the clinical value, safety, and efficacy of the combined intervention in comparison with nerve pulsed radiofrequency surgery alone.
Overall, 72 participants suffering from herpes zoster neuralgia (subacute stage) were segregated into 2 arms with matched clinical symptoms, age, and gender. Both the arms were treated with pulsed radiofrequency for affected nerve segments under the DSA technique. Five days post-operation, arm A (n = 36) was given 0.9% saline intravenously (50 ml/day) and arm B (n = 36) was administered lidocaine intravenously for 5 consecutive days (3 mg/kg/day). Subjects with poor pain control during the intervention were administered morphine (10 mg) tablets to reduce pain and attain visual analog scale (VAS) score ≤4.
Collection of following data was done: skin temperature measurement utilizing infrared thermography, 45 body area rating scale score, Pittsburgh sleep quality score (PSQI), depression self-rating scale (SDS) score, self-rating anxiety scale (SAS) score, VAS score, analgesic drug use pre and post-intervention at 6 distinct time-points. The time points were prior to the surgery (T0), one day post-surgery (T1), three days post-surgery (T2), five days post-surgery (T3), one month post-surgery (T4), and two months post-surgery (T5). In the morning prior to the surgery and following the last lidocaine administration (T3), collection of blood from all subjects was done.
Examination of serum inflammatory indexes incorporating interleukin-6 (IL-6), calcitonin gene-related peptide (CGRP) level, C-reactive protein (CRP) level, erythrocyte sedimentation rate count, neutrophils count, lymphocyte count, and white blood cell count was done. The occurrence of side effects and complications throughout the study were documented.
Notably, 64 subjects were able to complete the study. Following symptomatic treatment, alleviation of adverse symptoms was noted. No severe complications like nerve injury, pneumothorax, and hematoma at puncture site were witnessed in both the arms. There was a substantial decrease in the mean of PSQI score, SDS score, SAS score, VAS score, and skin temperature of both the groups at every time point following interventional surgery vs. before intervention.
The above indicators of arm B subjects were remarkably less than arm A subjects at every time point following surgery. Following therapy, the analgesic intake was found to be substantially lower than before intervention in both the arms. The analgesic intake was considerably lower in arm B vs. arm A. At T3, both groups exhibited serum inflammatory indexes lower than T0.
In particular, the interleukin-6 level, CGRP level, CRP level, and erythrocyte sedimentation rate of arm B were lower than those of arm B. The occurrence of postherpetic neuralgia in arm B subjects (6.25%) was less than in arm A subjects (25%). Hence, pulse radiofrequency in combination with intravenous lidocaine infusion can effectively treat subacute herpes zoster neuralgia.
Pain Research and Management
Clinical Efficacy of Pulsed Radiofrequency Combined with Intravenous Lidocaine Infusion in the Treatment of Subacute Herpes Zoster Neuralgia
Wanyun Zhang et al.
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