Efficacy Of Transversus Abdominis Plane Block Combined With Pulsed Radiofrequency And Its Effect On Immune Function Of Patients With Postherpetic Neuralgia

ObjectiveTo explore the clinical efficacy of ultrasound-guided transversus abdominis plane block(TAPB)combined with pulsed radiofrequency in the treatment of postherpetic neuralgia(PHN)and the effect on immune function of patients with PHN,and to explore the effect of TAPB combined with dexamethasone on the therapeutic effect.Subjects and Methods93 patients with abdominal wall PHN who were admitted to the Pain Department of the First Affiliated Hospital of Zhengzhou University from August 2019 to August 2020 were selected and divided into pulsed radiofrequency group(group C),pulsed radiofrequency combined with TAPB(0.375%ropivacaine 20ml)(group R)and pulsed radiofrequency combined with TAPB(0.375%ropivacaine 20ml containing 5mg dexamethasone)(group D)by random number table.All patients in three groups were treated with CT-guided pulsed radiofrequency surgery of thoracic dorsal root ganglion.Patients in group R and group D were treated with TAPB on the basis of pulsed radiofrequency,once every three days,that is,on the day after pulsed radiofrequency operation,on the 3rd day and on the 6th day after operation.The VAS score,Generalized Anxiety Disorder-7(GAD-7)score,Patient Health Questionnaire-9(PHQ-9)score and daily dose of pregabalin were recorded on the 1 day of admission(T0),7 day after pulsed radiofrequency surgery(T1),1 month after treatment(T2),3 month after treatment(T3)and 6 month after treatment(T4),and the markedly effective rate of each group was calculated according to VAS score.The use of oxycodone and acetaminophen tablets at T0 and T4 was recorded.The Self-Rating Scale of Sleep(SRSS score)of T0,T2,T3 and T4 was recorded.The Pressure Pain Thresholds(PPTs)of the pain site of the three groups was measured by DS2-200N digital push-pull force gauge at T0,3rd day after pulsed radiofrequency surgery(before the second TAPB operation,d3),6th day after pulsed radiofrequency surgery(before the third TAPB operation,d6)and T1.Fasting venous blood samples were taken to detect the absolute counts of CD3+and CD4+T lymphocytes,the number of CD4+T/CD8+T lymphocytes and the percentage of NK cells in the peripheral blood of the three groups of patients when they got up in the morning and fasting at T0 and T1 time points.At the same time,the adverse reactions and serious complications of the three groups were recorded during the treatment period and during the follow-up.Results1.82patients were finally included in the analysis,including group C(n=27),group R(n=28)and group D(n=27).There was no significant difference in age,sex,course of disease,disease side,VAS score,PPTs,GAD-7 score,PHQ-9 score,SRSS score,daily pregabalin dosage,the utilization rate of oxycodone and acetaminophen tablets and the absolute count of CD3+,CD4+T cells,the number of CD4+T/CD8+T cells as well as percentage of NK cells in peripheral blood of patients among the three groups at T0(P>0.05).2.Comparison among groups:The VAS score,GAD-7 score and PHQ-9 score at T1,T2,T3 and T4 were significantly lower than those at T0 in the three groups(P<0.05);The VAS score at T4 in group C was significantly higher than that at T3(P<0.05);The PPTs at d3,d6 and T1 in the three groups were significantly higher than those at T0(P<0.05);In group C,the daily pregabalin dosage at T1 and T2 was not significantly different from that at T0(P>0.05),but the daily pregabalin dosage at T3 and T4 was significantly lower than that at T0 in group C(P<0.05);The daily dosage of pregabalin at T1 in group R and group D was not significantly different from that at T0(P>0.05),but the daily pregabalin dosage at T2,T3,T4 in group R and group D was significantly lower than that at T0(P<0.05);The number of patients treated with oxycodone and acetaminophen tablets at T4 was significantly lower than that at T0 in three groups(P<0 05).The SRSS scores at T2,T3 and T4 in the three groups were obviously lower than those at T0(P<0 05);The absolute count of CD4+T cells and the number of CD4+/CD8+T cells in the three groups at T1 was obviously higher than that at T0(P<0.05);There was no obvious difference in the absolute count of CD3+T cells and the percentage of NK cells between T1 and T0 among the three groups(P>0.05).3.Comparison between groups:The VAS score,GAD-7 score and PHQ-9 score in group R and D were significantly lower than those in group C at T1,T2,T3 and T4(P<0.05);There was no significant difference in VAS score,GAD-7 score,PHQ-9 score and daily pregabalin dosage between group R and group D at each time point(P>0.05);The daily dosage of pregabalin of group R and group D at T1,T2,T3 and T4 was significantly lower than that in group C(P<0.05).There was no significant difference in the utilization rate of oxycodone and acetaminophen tablets at T4 among the three groups(P>0.05).The PPTs of group R and group D at d3,d6 and T1 was obviously higher than that of group C(P<0 05);There was no significant difference in PPTs between group R and group D at d3 and d6(P>0.05),but the PPTs of group D was higher than that of group R at T1(P<0 05);The SRSS scores of group R and group D at T2 and T3 were obviously lower than those of group C at T2 and T3(P<005),but there was no significant difference in SRSS score among the three groups at T4(P>0.05);There was no significant difference in the SRSS score at each time point between group R and group D(P>0.05);There was no significant difference in the absolute count of CD4+T and CD3+T cells,the number of CD4+/CD8+T cells and the percentage of NK cells among the three groups at T0 and T1(P>0.05);There was no obvious difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion1.Compared with pulsed radiofrequency therapy for PHN,ultrasound-guided TAPB combined with pulsed radiofrequency treatment of PHN had a better clinical effect,which was helpful to relieve pain,improve sleep quality and mental health status.2.Pulsed radiofrequency combined with drugs can improve the immune function of patients with PHN,while TAPB treatment has no significant effect on the immune function of patients with PHN.3.Ultrasound-guided TAPB combined with dexamethasone injection has no significant effect on the therapeutic of PHN.