A simple sonographic approach to thoracic transforaminal epidural injections for zoster-associated pain involving multiple nerves: an exploratory prospective cohort study
Background A simple superoposterior approach to thoracic transforaminal epidural injections (TFEIs) under ultrasonographic guidance was proposed to reduce zoster-associated pain (ZAP) involving multiple thoracic nerves and the likelihood of transitioning to postherpetic neuralgia (PHN). Methods Pati...
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Korean Society of Anesthesiologists
2025-06-01
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| author | Shuyue Zheng Dan Wang Li Yue Liangliang He |
| author_facet | Shuyue Zheng Dan Wang Li Yue Liangliang He |
| author_sort | Shuyue Zheng |
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| description | Background A simple superoposterior approach to thoracic transforaminal epidural injections (TFEIs) under ultrasonographic guidance was proposed to reduce zoster-associated pain (ZAP) involving multiple thoracic nerves and the likelihood of transitioning to postherpetic neuralgia (PHN). Methods Patients were prospectively enrolled. Primary endpoints were the burden of illness (BOI) scores and epidural contrast spread. Secondary endpoints included number of needle insertion attempts, sensory blockade, hemodynamic changes, procedure time, radiation dose, adverse events, rescue analgesics, PHN incidence and EuroQoL 5-Dimension scores. Results Thirty-five injections were performed in 27 patients. Median levels of cephalad-caudad epidural contrast spread were 3, 4, and 5 ml following injections of 2, 3, and 4 ml. Dorsal epidural spread was observed at levels 3, 4, and 5, whereas concurrent ventral spread was observed at levels 2, 3, and 4. BOI scores at 30–180 days significantly decreased (mean difference: −25.3, 95% CI [−57.4 to 6.6], P = 0.005), accounting for reduced rescue analgesic requirements and PHN occurrence and improved EuroQoL 5-Dimension scores. Median sensory blockade at 5 min post-procedure was at level 2, 3, and 4 after 2, 3, and 4 ml of therapeutic injectate. No significant hemodynamic changes were noted at 15 min post-injection. No serious adverse events were observed. Conclusions Spread of thoracic epidural contrast to all involved nerves was confirmed using this novel technique. Simplified needle placement reduced the technical difficulty and risk of complications. It might be a promising alternative approach for ZAP. |
| format | Article |
| id | doaj-art-ffb15c44baa04f07b24a54d10ea1c03b |
| institution | Matheson Library |
| issn | 2005-6419 2005-7563 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Korean Society of Anesthesiologists |
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| series | Korean Journal of Anesthesiology |
| spelling | doaj-art-ffb15c44baa04f07b24a54d10ea1c03b2025-07-31T09:17:03ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632025-06-0178323624710.4097/kja.248189039A simple sonographic approach to thoracic transforaminal epidural injections for zoster-associated pain involving multiple nerves: an exploratory prospective cohort studyShuyue Zheng0Dan Wang1Li Yue2Liangliang He3 Department of Pain Management, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China Department of Pain Management, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing City, China Department of Pain Management, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing City, China Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, ChinaBackground A simple superoposterior approach to thoracic transforaminal epidural injections (TFEIs) under ultrasonographic guidance was proposed to reduce zoster-associated pain (ZAP) involving multiple thoracic nerves and the likelihood of transitioning to postherpetic neuralgia (PHN). Methods Patients were prospectively enrolled. Primary endpoints were the burden of illness (BOI) scores and epidural contrast spread. Secondary endpoints included number of needle insertion attempts, sensory blockade, hemodynamic changes, procedure time, radiation dose, adverse events, rescue analgesics, PHN incidence and EuroQoL 5-Dimension scores. Results Thirty-five injections were performed in 27 patients. Median levels of cephalad-caudad epidural contrast spread were 3, 4, and 5 ml following injections of 2, 3, and 4 ml. Dorsal epidural spread was observed at levels 3, 4, and 5, whereas concurrent ventral spread was observed at levels 2, 3, and 4. BOI scores at 30–180 days significantly decreased (mean difference: −25.3, 95% CI [−57.4 to 6.6], P = 0.005), accounting for reduced rescue analgesic requirements and PHN occurrence and improved EuroQoL 5-Dimension scores. Median sensory blockade at 5 min post-procedure was at level 2, 3, and 4 after 2, 3, and 4 ml of therapeutic injectate. No significant hemodynamic changes were noted at 15 min post-injection. No serious adverse events were observed. Conclusions Spread of thoracic epidural contrast to all involved nerves was confirmed using this novel technique. Simplified needle placement reduced the technical difficulty and risk of complications. It might be a promising alternative approach for ZAP.http://ekja.org/upload/pdf/kja-24818.pdfherpes zosterinjections, epiduralneuralgia, postherpeticspinal canalthoracic spineultrasonographyvertebral foramen |
| spellingShingle | Shuyue Zheng Dan Wang Li Yue Liangliang He A simple sonographic approach to thoracic transforaminal epidural injections for zoster-associated pain involving multiple nerves: an exploratory prospective cohort study Korean Journal of Anesthesiology herpes zoster injections, epidural neuralgia, postherpetic spinal canal thoracic spine ultrasonography vertebral foramen |
| title | A simple sonographic approach to thoracic transforaminal epidural injections for zoster-associated pain involving multiple nerves: an exploratory prospective cohort study |
| title_full | A simple sonographic approach to thoracic transforaminal epidural injections for zoster-associated pain involving multiple nerves: an exploratory prospective cohort study |
| title_fullStr | A simple sonographic approach to thoracic transforaminal epidural injections for zoster-associated pain involving multiple nerves: an exploratory prospective cohort study |
| title_full_unstemmed | A simple sonographic approach to thoracic transforaminal epidural injections for zoster-associated pain involving multiple nerves: an exploratory prospective cohort study |
| title_short | A simple sonographic approach to thoracic transforaminal epidural injections for zoster-associated pain involving multiple nerves: an exploratory prospective cohort study |
| title_sort | simple sonographic approach to thoracic transforaminal epidural injections for zoster associated pain involving multiple nerves an exploratory prospective cohort study |
| topic | herpes zoster injections, epidural neuralgia, postherpetic spinal canal thoracic spine ultrasonography vertebral foramen |
| url | http://ekja.org/upload/pdf/kja-24818.pdf |
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