1 case of intra-neal blocking combined ozone treatment shingles itching

Chickenpox - The shingles virus causes pain and even severe itching after invading the sensory nerveThe literature reports that the persistent itching of shingles is mostcommonly seen in the subacute and chronic stage of shingles, when the effect of itching drug treatment after shingles is poor, the current treatment methods such as pulse radio frequency therapy, neuroelectric stimulation, epidural analgesic drug treatment, this study in theclinicalwork encountered a case of shingles patients in acute stage of conformation appeared stubborn itching Itching, itching score using visual analog scoring method (visual analoge scale, VAS) to achieve 10 points, seriously interfere with the patient's life and sleep, to solve the patient's suffering, improve the patient's quality of life, give antiviral, nutritional nerve, neurorepair regulatory drugs, antihistamines, calcium ion channel regulators and other drug treatment is ineffective, and give the epithelial joint ozone treatment after good results, is reported below1Methods1.1 General information
patients, males, 23 years old, mainly due to left shoulder joint movement limited for more than 6 weeks admissionThe patient's left shoulder joint habitually dislocated in the orthopaedic line left shoulder joint cystic repair surgery, 6 weeks after surgery due to the left shoulder joint movement restriction needs further rehabilitation treatment in my department (pain rehabilitation department) hospital treatment, the third day of admission to the hospital consciously left thigh front side itching, exposed left thigh found in the front side of the thigh appeared in the front side of the flaky red spot, erythema visible cluster-sized granulal-sized water herpes, pain hypersensitivity,diagnosedshingles, given a static point ascelovir injection and external spray-seroso Wei ointment antiviral treatment, while giving B vitamin nutrition nerve therapy, patients left thigh inside and outside the red spots and blisters, patientanti-viral and nutritional nerve treatment 1 week after herpes clotting, but the patient complains about the inner thigh, front and outside severe itching, itching on the outside side obvious, even if scratching itching skin still can not alleviate symptoms, itching area has mild pain, night sleep 1 to 3 hours of VASs1.2 treatmentaccording to the symptoms of itching, itching mainly, has been oral Malayacid chlorophenynasenic tablets, chlorreate tablets after night to fall asleep, but in the morning found that the thigh skin was scratched, and then gave oral gaba dincapsules, Pribarin capsules and static point bovine bovine pox vaccine after the rabbit skin extract injection no relief tendencyNo bleeding tendency, abnormal blood clotting function, by the patient signed an informed consent, arrangements lumbar vertebral obstruction lag itch pain still no relief, herpes clotting shedding, arranged herpes itching site intraderave joint ozone treatment 3 times, interval of 1 weekintracutaneous blocking joint ozone treatment: patients take reclining, exposed the inner, front and outside of the left thigh, touch the left thigh herpes itching area as blocking point, routine disinfection, wearing sterile gloves, spread sterile hole towel, with 10 ml syringe sending 1 ml of needle for puncture needle, according to itchy skin area to remove inflammatory analis (2% Lidoka 3 ml mg .9% physiological saline 25ml), injection of 1.5 cm diameter picchu in the blocking area, picho interval 1 cm, and then according to the itching area to extract 20 sg/ml ozone injection in the blocking area, a total of 30 ml ozone, injection, extraction needle, routine disinfection, dressing cover, bandage bandage, patient without discomfort, flat 20min after the ward 2 Results patients blocked treatment after 1 degree of itching reduced, itching area reduction, itching VAS score 6 points, pain VAS score 1 score, patient block treatment 2 itching VAS score 3, pain VAS score 0, block treatment after 3 itching VAS score 0, pain VAS score 0, follow-up 1, 2, March no recurrence, sleep normal No complications and adverse reactions occurred 3 Discussion of Clinical observation of the acute stage of shingles causing stubborn itching is rare, its incidence is rarely reported at home and abroad, Ozdemir and other studies of 178 cases of shingles patients in 20 cases of combined itching, before the disease has 2 cases, 16 cases of disease, after treatment of 2 cases In the study, 96% of patients with shingles found damaged peripheral nerves, which also confirmed that itching caused by shingles is neuropathic itching, the current clinical no effective treatment for itching, the treatment of itching antihistamines on the effect of neuropathic itching is not obvious Pepper spicy and local anaesthetic drugs such as lidocain are commonly used for neuropathic itching Kopecky et al used a mixture of the hemp drug Lidocarin and amine cain to treat itching, and found that it significantly reduced itching and frequency of seizures In 2013, the Chinese Physicians Association Dermatologist Branch, the "China Shingles Treatment Guidelines" expert group pointed out that siphacin ointment by affecting pain, transfer factor P substance release synthesis and storage, to achieve analgesic and itching effect However, the efficacy of this medicine was not observed because the pharmacy in our hospital did not have this medicine itching caused by shingles may be due to the virus transferred to the skin through sensory axons, spread from one cell to another, penetrating the epidermis, under which the skin cells are keratin cells, epithelial cells and endothelial cells secrete amines, 5-serotonin, neuropeptides, prostaglands and other endogenous itching substances, stimulate the release of heteroamine in large cells or directly stimulate the skin C The end of the fiber-like body induces itching of the skin, and itching causes itching reflexes, through scratching to relieve itching, but scratching increases inflammatory media (histamine, serotonin, prostaglandins, etc.) to release and stimulate nerve C fibers, resulting in a vicious circle of "itching-scratching-itching", which interrupts this vicious cycle of drugs or treatment is a new entry point to relieve itching intracutaneous blocking combined ozone treatment shingles itching, it can break the "itching - scratching - itching" vicious circle, first in the itching area of intraderal blocking, intra-neal blocking lidocarine in the skin block by applying to the skin tissue by suppressing the link between fat cells and nerve fibers to stop itching, while Lidoka because of the action of nerve endings, blocking the nerve Conduction function, so that local tissue or the corresponding nerve-dominant areas produce temporary, reversible sensory loss, and thus reduce pain and itching, which is to block the vicious cycle of "itching-scratching"; Studies have shown that histamines, serotonin, neuropeptides (neuropeptide Y, P substances), prostaglandins, norepinephrine chemicals in the serum of herpes patients are significantly elevated, and these substances are itchy; These itchy, pain-causing chemicals and itchy, pain-causing compounds are synthesized and released, thus playing the role of itching and analgesic, while intracutorin blocking relieves the pain caused by direct injection of low-concentration ozone, thus alleviating the pain caused by treatment to patients Therefore, intra-dermal blocking combined ozone treatment stubborn shingles itching can be used as a trial method, this method also needs to be further practiced and perfected in the future work