Effectiveness of CT-guided epidural infiltration of steroids and local anesthetics for acute and chronic herpes zoster neuralgia

Abstract

PurposeThe purpose of this study was to evaluate the effectiveness and complication rate of computed tomography (CT)-guided epidural injection of steroids and local anesthetics for pain relief in patients with neuralgia due to acute or chronic herpes zoster (HZ). Materials and methodsA prospective study was conducted from April 2017 to February 2019 including patients with HZ neuralgia (HZN) at any stage (acute or chronic, the latter being defined as pain lasting more than 3 months and also called post herpetic neuralgia [PHN]). The sensory ganglion of the affected dermatome and/or the affected sensory nerve was targeted under CT-guidance and local injection of a mixture of two vials of methylprednisolone 40mg/mL and 2mL of Lidocaine 1% was performed. Using a visual analogue scale (VAS, 0 to 10), pain was assessed prior to the procedure, and at day 7, 1 month, 3 months and 6 months. Adverse effects were graded according to the Society of Interventional Radiology classification. ResultsTwenty patients were included. There were 9 men and 11 women with a mean age of 67±13.9 (SD) years (range: 27–83 years). Of these, 14 patients had acute HZN and 6 had PHN. Mean VAS at baseline was 8.1±1.2 (SD) (range: 6–10) with significant decrease (P<0.0001) at day 7 (3.4±3.2 [SD]; range: 0–10), day 30 (3.4±3.2 [SD]; range: 0–9), day 90 (2.9±3.2 [SD]; range: 0–9), and day 180 (2.5±3.1 [SD]; range: 0–9). Infiltrations were significantly more effective on acute HZN than on PHN (P<0.001) and required significantly fewer infiltrations for pain relef (P=0.002). Only one grade A adverse event was reported. ConclusionEpidural injection of a mixture of steroids and local anesthetics under CT-guidance is effective on HZN with a persisting effect over 6 months.