Efficacy of erector spinae plane block in pain management for patients with herpes zoster: a systematic review and meta-analysis

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology Pub Date : 2025-03-01 DOI:10.1016/j.bjane.2025.844598

Alexandre Yamada Fujimura Júnior , Carolina Braga Moura , Arnaldo Bastos dos Santos

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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.

Study Registration Number and Date

This article was prospectively registered in PROSPERO (www.crd.york.ac.uk/prospero, CRD42024566674).

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目的：系统回顾和荟萃分析通过系统综述和荟萃分析评估脊柱后凸肌平面阻滞疗法（ESPB）治疗带状疱疹相关疼痛的疗效：我们系统地检索了 PubMed、Embase、Cochrane Library 和 CNKI 中比较 ESPB 加标准临床治疗与单纯临床治疗的随机试验。研究对象包括急性感染患者和带状疱疹后遗神经痛（PHN）患者。主要研究结果为疼痛强度，次要研究结果包括镇痛药消耗量。连续结果采用平均差（MD），二元结果采用风险比（RR）：结果：共纳入了 7 项试验，362 名患者接受了治疗。ESPB可明显减轻疼痛达8周（MD = -1.21; 95% CI -2.17 to -0.24；I2 = 89%）。在对急性期患者进行的亚组分析中，疼痛减轻的时间似乎延长至 12 周（MD = -1.49; 95% CI -2.61 to -0.37；I2 = 0%），PHN 的发生率也有所降低（RR = 0.49; 95% CI 0.28 to 0.85；I2：0%）。在PHN亚组中，只有在四周时疼痛才明显减轻（MD = -1.08; 95% CI -1.81 to -0.35；I2 = 86%）。在 12 周内，ESPB 还减少了对乙酰氨基酚的用量（MD = -0.6 克/天-1；95% CI -1.05 至 -0.14；I2 = 49%）和普瑞巴林的用量（-68.58 毫克/天-1；95% CI -127.18 至 -9.97；I2 = 41%）：ESPB似乎可以缓解带状疱疹患者的疼痛，并在急性期延长疗效。此外，ESPB还能在12周内减少镇痛剂的使用。需要更多的研究来证实这一做法。研究注册编号和日期：本文在 PROSPERO 上进行了前瞻性注册（www.crd.york.ac.uk/prospero，CRD42024566674）。

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