Frontal and Nasal Nerve Blocks in the Treatment of Severe Pain in Acute Ophthalmic Zoster

Abstract

To the Editor: Acute ophthalmic zoster (OZ) is frequently accompanied by severe pain in the frontal and nasal branches of the ophthalmic nerve (ON) in elderly patients. Rapid relief is particularly important in these patients because their daily activities are disrupted (1), but is often difficult owing to the iatrogenic effects of antalgics (2). We report an original treatment of this pain: peripheral blockades of the ON. Twenty patients (mean age 76 ± 7 years, range 63–88) were referred to our pain center with severe pain (mean VAS 74 ± 10, range 60–100) stubborn to proper analgesic treatment. We performed daily frontal and/or nasal blocks of 1 mL of bupivacaine with 0.25% adrenaline added to 12.5 μg of clonidine until VAS <40. All patients experienced less pain after the first injection. The number of blocks per patient was 2.3 ± 0.7 (range 1–4). The mean aily VAS fell to 48 ± 10, 41 ± 11, 35 ± 10, 32 ± 6 and 28 ± 9 between days 1 and 5 (P <0.001). All pain-associated symptoms were improved, and sleep disturbance was reduced. All patients’ analgesic medication, especially morphine, could be substantially reduced. No side effects were observed. These findings are preliminary data for a new treatment of pain in acute OZ. A controlled study is necessary for verification. Philippe Gain, MD, PhD Gilles Thuret, MD Christophe Chiquet, MD Marie-Louise Navez, MD Jean Pascal, MD