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      Bloqueo retrolaminar ecoguiado como analgesia para el manejo de neuralgia por herpes zóster: a propósito de un caso Translated title: Retrolaminar ultrasound guided block as analgesic treatment for post herpetic neuralgia: case report

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          Abstract

          RESUMEN Los bloqueos interfasciales (BIF) son el resultado de inyectar un anestésico local en el espacio comprendido entre dos fascias con el objetivo de distribuir el volumen y bloquear la transmisión nerviosa correspondiente. La introducción de los BIF como técnica anestésico-analgésica es relativamente reciente. Su amplia difusión y estandarización en estos últimos años ha venido de la mano del uso de ultrasonidos; como resultado ha aumentado la eficacia de los bloqueos y la seguridad en la práctica de los mismos. El bloqueo retrolaminar (RL) y el bloqueo del plano del erector espinal (ESP) comparten características similares y pueden considerarse una alternativa analgésica para los dolores relacionados con afectación de la pared torácica, siendo el bloqueo RL de gran valor en pacientes con riesgo de neumotórax o en quienes no se obtenga adecuada visualización de la sonoanatomía para el bloqueo ESP. Se describe el caso de un paciente con neuralgia aguda por herpes zóster, a quien se le realizó un bloqueo RL exitoso.

          Translated abstract

          ABSTRACT Interfacial plane blocks (IPB) are the result of the injection of an anesthetic locally in the space created between two fasciae with the purpose of distributing the volume of the medication and block the transmission of the corresponding nerves. The introduction of IPB as an analgesic anesthetic technic is relatively resent, and its widespread and standardization this last few years has come by hand of the ultrasound, as a result the safety and efficiency of the IPB has increased. The retrolaminar block (RB) and the Spinal erector plane block (SPB) share characteristics and could be considered as an alternative to manage the thoracic wall pain pathologies, keeping in mind that the RB is of choice for patients in danger of suffering a pneumothorax or in those in which there is an inappropriate anatomic visualization though the echography for the SPB. In this article a case of a patient with acute neuralgia due to herpes zoster who received a successful RB is described.

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          Erector Spinae Plane Block Versus Retrolaminar Block: A Magnetic Resonance Imaging and Anatomical Study.

          The erector spinae plane (ESP) and retrolaminar blocks are ultrasound-guided techniques for thoracoabdominal wall analgesia involving injection into the musculofascial plane between the paraspinal back muscles and underlying thoracic vertebrae. The ESP block targets the tips of the transverse processes, whereas the retrolaminar block targets the laminae. We investigated if there were differences in injectate spread between the 2 techniques that would have implications for their clinical effect.
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            Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study.

            Although different injection locations for retrolaminar and erector spinae plane blocks have been described, the two procedures have a similar anatomical basis. In this cadaveric study we compared anatomical spread of dye in the thoracic region following these two procedures. Following randomisation, 10 retrolaminar blocks and 10 erector spinae plane blocks were performed on the left or right sides of 10 unembalmed cadavers. For each block, 20 ml of dye solution was injected at the T5 level. The back regions were dissected and the involvement of the thoracic spinal nerve was also investigated. Twenty blocks were successfully completed. A consistent vertical spread, with deep staining between the posterior surface of the vertebral laminae and the overlaying transversospinalis muscle was observed in all retrolaminar blocks. Moreover, most retrolaminar blocks were predominantly associated with fascial spreading in the intrinsic back muscles. With an erector spinae plane block, dye spread in a more lateral pattern than with retrolaminar block, and fascial spreading in the back muscles was also observed. The number of stained thoracic spinal nerves was greater with erector spinae plane blocks than with retrolaminar blocks; median 2.0 and 3.5, respectively. Regardless of technique, the main route of dye spread was through the superior costotransverse ligament to the ipsilateral paravertebral space. Although erector spinae plane blocks were associated with a slightly larger number of stained thoracic spinal nerves than retrolaminar blocks, both techniques were consistently associated with posterior spread of dye and with limited spread to the paravertebral space.
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              Management of herpes zoster and post-herpetic neuralgia.

              Herpes zoster and its sequela post-herpetic neuralgia (PHN) are conditions with significant morbidity. PHN is a chronic, debilitating neuropathic pain that can persist long beyond resolution of visible cutaneous manifestations. This paper provides practical guidelines for management of herpes zoster and PHN. For herpes zoster, antivirals should be started, preferably within 72 h of onset, to reduce the severity and duration of the eruptive phase and to reduce the intensity of acute pain. PHN can be treated with either topical or systemic agents. Topical lidocaine and capsaicin are effective. For patients with more severe pain, the following systemic agents can be considered (in decreasing order of recommendation): the anticonvulsants gabapentin and pregabalin, the tricyclic antidepressants amitriptyline, nortriptyline, and desipramine, and, lastly, the opioid analgesics tramadol, morphine, oxycodone, and methadone. For patients at high risk of developing PHN, early initiation of gabapentin or amitriptyline after the onset of herpes zoster is suggested. The new zoster vaccine has been shown to be effective in reducing the incidence of herpes zoster and PHN.
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                Author and article information

                Journal
                dolor
                Revista de la Sociedad Española del Dolor
                Rev. Soc. Esp. Dolor
                Inspira Network Group, S.L (Madrid, Madrid, Spain )
                1134-8046
                December 2021
                : 28
                : 6
                : 350-353
                Affiliations
                [4] Medellín orgnameUniversidad Pontificia Bolivariana orgdiv1Anestesiología Colombia
                [5] Medellín Antioquía orgnameUniversidad CES Colombia
                [3] Bogotá Arauca orgnameUniversidad Nacional de Colombia orgdiv1Dolor y Cuidados Paliativos Colombia
                [2] Chía orgnameClinica Marly Jorge Cavelier Gaviria orgdiv1Dolor y Cuidados Paliativos Colombia
                [1] Medellín orgnameClínica Las Américas orgdiv1Dolor intervencionista Colombia
                Article
                S1134-80462021000700350 S1134-8046(21)02800600350
                10.20986/resed.2022.3920/2021
                20a28be0-ecdd-48da-816b-822ae187de85

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 26 January 2022
                : 08 May 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 11, Pages: 4
                Product

                SciELO Spain

                Categories
                Notas Clínicas

                acute pain,Analgesic block,herpes zoster,shingles,postherpetic neuralgia,Bloqueo analgésico,herpes zóster,dolor agudo,neuralgia postherpética

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