The Effect of Erector Spinae Plane Blockade on Prevention of Postherpetic Neuralgia in Elderly Patients: A Randomized Double-blind Placebo-controlled Trial.
Bibliographic record
Abstract
BACKGROUND: Postherpetic neuralgia (PHN) is the most common chronic complication following the onset of herpes zoster (HZ). Both the incidence of HZ and the proportion of patients with HZ who develop PHN rise with age. Ultrasound-guided erector spinae plane blockade (ESPB) has been reported to relieve neuropathic pain and PHN in elderly patients, but no randomized controlled trials have been conducted regarding the effect of ESPB on elderly patients with HZ in the acute or subacute phases. OBJECTIVES: To evaluate the effect of repeated ESPB on the occurrence of PHN in elderly patients with acute or subacute HZ. STUDY DESIGN: A randomized double blind placebo-controlled trial with 2 parallel groups. SETTING: A university hospital in China. METHODS: Patients diagnosed with acute or subacute HZ were randomized to receive either ultrasound-guided ESPB (the ESPB group) or placebo subcutaneous injection (the control group) every 24 hours for 3 days. Patients were followed up at 12 weeks after the final treatment. The primary end point was the incidence of PHN at 12 weeks. RESULTS: A total of 52 patients were enrolled and randomized; 50 completed 12 weeks of follow-up. The incidence of PHN at 12 weeks was significantly lower in the ESPB group (15.4% [4/26]) than in the control group (41.7% [10/24]); relative risk 0.37, 95% confidence interval 0.13-1.02, P = 0.039. At 12 weeks, the VAS scores at rest and the total scores from the Short-Form McGill Pain Questionnaire-2 were significantly decreased in the ESPB group (P = 0.046 and P = 0.001, respectively). The incidence of neuropathic pain, sleep disturbance, and anxiety/depression were significantly reduced in the ESPB group (P = 0.002, P = 0.002, and P = 0.025, respectively). Patients using tramadol and hypnotics as well as total complications with oral medicines were remarkably decreased in the ESPB group (P = 0.008, P = 0.002, and P = 0.042 respectively). The adverse events during or after the procedure were comparable between the groups. LIMITATIONS: This trial was carried out in a single center with a 12-week follow-up. Nearly 8% of patients in the control group were lost to follow-up. CONCLUSIONS: For elderly patients suffering acute or subacute HZ, ESPB reduces the incidence of PHN at 12 weeks after treatment; it also decreases the occurrence of neuropathic pain, sleep disturbance, and anxiety/depression.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".