Role of ultrasound guided erector spinae plane block in management of acute herpes zoster pain and incidence of post-herpetic neuralgia

Abstract

ABSTRACT Background: Severe zoster-associated pain limits patient’s daily activity and may significantly lower the patient’s quality of life. The current study aimed to improve the patient’s quality of life by adding ESPB to the current medical therapy. The primary outcome was to improve pain control in acute stage, while the secondary outcome was to reduce the incidence of PHN. Settings and Design: This study was a prospective randomized controlled trial. Methods: This study was carried out on 40 patients between 20 and 60 years old suffering from acute thoracic HZ. Patients were randomly classified into two groups: one group received ESPB, using 0.25% bupivacaine 20 ml and 40 mg methylprednisolone single shot in the thoracic dermatome corresponding to the rash, together with the conventional medical treatment for herpes zoster, and the second group only received medical treatment. Once the pain started to decrease, Pregabalin dose was reduced. Acetaminophen was used as a rescue analgesic. Pain scores,PGIC, and the average doses of Pregabalin and Acetaminophen were calculated at each visit. The time to complete resolution of pain and incidence of PHN were recorded. Follow-up was done for 3 months after the first visit. Results: Pain intensity was significantly lower in the group receiving the block at the second and fourth weeks after the block was performed. The time to complete resolution of pain was significantly longer in the medical group. Two patients progressed to PHN in the block group (10%) versus six patients in the medical group (30%). The average Pregabalin and Acetaminophen doses in the second 14 days, and the following 56 days was statistically significantly lower in the block group. Patient satisfaction was significantly higher in patients in the block group at the second and fourth weeks after the receiving the block. Conclusion: ESPB in conjunction with medical treatment can be beneficial in decreasing pain intensity in patients with acute thoracic herpes zoster more rapidly than conventional medical treatment.