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Efficacy of continuous epidural infusion with epidural electric stimulation compared to conventional continuous epidural infusion for acute herpes zoster management: A retrospective study
Sang Sik Choi
Korea University Guro Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0260-9886
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This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Anesthesiology.
Background: A continuous epidural infusion is commonly used in clinical settings, and reduces the likelihood of transition to postherpetic neuralgia via pain control. The purpose of the present study was to compare the efficacy of conventional continuous epidural infusion to that of continuous epidural infusion where the catheter is specifically guided by electric stimulation to areas with neurological damage in the treatment of zoster-related pain and prevention of postherpetic neuralgia.
Methods: We analyzed the medical records of 114 patients in the present study. The patients were divided into two groups: contrast (conventional continuous epidural infusion), and stimulation (continuous epidural infusion with epidural electric stimulation). In the contrast group, the position of the epidural catheter was confirmed using contrast medium alone, whereas in the stimulation group, the site of herpes zoster infection was identified through electric stimulation using a guidewire in the catheter. Clinical efficacy was assessed using a numerical rating scale (pain score) up to 6 months after the procedures. We compared the percentage of patients who showed complete remission (pain score less than 2, and no further medication) in each group. We also investigated whether the patients required additional interventional treatment due to insufficient pain control during the 6-month follow-up period after each procedure.
Results: After adjusting for confounding variables, the pain score was significantly lower in the stimulation group than in the contrast group for 6 months after the procedure. The adjusted odds ratio of patients included in the complete remission category was 1.9 times higher in the stimulation group than in the contrast group (95% confidence interval: 0.81-4.44, P = 0.14). The adjusted odds ratio for other interventions within 6 months after the procedure was 3.62 times higher in the contrast group than in the stimulation group (95% confidence interval: 1.17-11.19, P = 0.03).
Conclusion: Epidural drug administration to specific spinal segments using electric stimulation catheters may be more helpful than conventional continuous epidural infusion for improving pain and preventing postherpetic neuralgia in acute phase of herpes zoster.
Keywords
herpes zoster, postherpetic neuralgia, epidural analgesia, continuous epidural infusion, electric stimulation.
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Editorial decision: Major revision
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Reviewer #1 agreed
On 21 Oct, 2019
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Editor invited
On 20 Oct, 2019
No comments provided
Editorial decision: Major revision
On 30 Sep, 2019
Reviewer #1 agreed
On 17 Sep, 2019
Review #1 received
Received 17 Sep, 2019
Review #2 received
Received 17 Sep, 2019
Reviewer #2 agreed
On 17 Sep, 2019
Reviewers invited
Invitations sent on 16 Sep, 2019
Submission checks complete
On 13 Sep, 2019
Editor assigned
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First submitted
On 30 Aug, 2019
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Subject Areas
Anesthesiology & Pain Medicine
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This preprint is under consideration at BMC Anesthesiology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Efficacy of continuous epidural infusion with epidural electric stimulation compared to conventional continuous epidural infusion for acute herpes zoster management: A retrospective study
Sang Sik Choi
Korea University Guro Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0260-9886
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Published
On 28 Jan, 2020
No community comments so far
Reviewer #1 agreed
On 16 Jan, 2020
Review #1 received
Received 16 Jan, 2020
Editor assigned
On 15 Jan, 2020
Reviewers invited
Invitations sent on 15 Jan, 2020
Submission checks complete
On 14 Jan, 2020
Editor invited
On 14 Jan, 2020
Version 2
Posted 25 Oct, 2019
No comments provided
Reviewer #3 agreed
On 05 Jan, 2020
Review #3 received
Received 05 Jan, 2020
Editorial decision: Major revision
On 05 Jan, 2020
Review #2 received
Received 28 Nov, 2019
Reviewer #2 agreed
On 10 Nov, 2019
Review #1 received
Received 05 Nov, 2019
Editor assigned
On 21 Oct, 2019
Reviewers invited
Invitations sent on 21 Oct, 2019
Reviewer #1 agreed
On 21 Oct, 2019
Submission checks complete
On 20 Oct, 2019
Editor invited
On 20 Oct, 2019
No comments provided
Editorial decision: Major revision
On 30 Sep, 2019
Reviewer #1 agreed
On 17 Sep, 2019
Review #1 received
Received 17 Sep, 2019
Review #2 received
Received 17 Sep, 2019
Reviewer #2 agreed
On 17 Sep, 2019
Reviewers invited
Invitations sent on 16 Sep, 2019
Submission checks complete
On 13 Sep, 2019
Editor assigned
On 03 Sep, 2019
Editor invited
On 02 Sep, 2019
First submitted
On 30 Aug, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Anesthesiology.
Background: A continuous epidural infusion is commonly used in clinical settings, and reduces the likelihood of transition to postherpetic neuralgia via pain control. The purpose of the present study was to compare the efficacy of conventional continuous epidural infusion to that of continuous epidural infusion where the catheter is specifically guided by electric stimulation to areas with neurological damage in the treatment of zoster-related pain and prevention of postherpetic neuralgia.
Methods: We analyzed the medical records of 114 patients in the present study. The patients were divided into two groups: contrast (conventional continuous epidural infusion), and stimulation (continuous epidural infusion with epidural electric stimulation). In the contrast group, the position of the epidural catheter was confirmed using contrast medium alone, whereas in the stimulation group, the site of herpes zoster infection was identified through electric stimulation using a guidewire in the catheter. Clinical efficacy was assessed using a numerical rating scale (pain score) up to 6 months after the procedures. We compared the percentage of patients who showed complete remission (pain score less than 2, and no further medication) in each group. We also investigated whether the patients required additional interventional treatment due to insufficient pain control during the 6-month follow-up period after each procedure.
Results: After adjusting for confounding variables, the pain score was significantly lower in the stimulation group than in the contrast group for 6 months after the procedure. The adjusted odds ratio of patients included in the complete remission category was 1.9 times higher in the stimulation group than in the contrast group (95% confidence interval: 0.81-4.44, P = 0.14). The adjusted odds ratio for other interventions within 6 months after the procedure was 3.62 times higher in the contrast group than in the stimulation group (95% confidence interval: 1.17-11.19, P = 0.03).
Conclusion: Epidural drug administration to specific spinal segments using electric stimulation catheters may be more helpful than conventional continuous epidural infusion for improving pain and preventing postherpetic neuralgia in acute phase of herpes zoster.
Figure 1
Figure 2
Figure 3