Abstract
IntroductionHerpes zoster is a well-known reactivating viral disease that gives rise to painful skin lesions. Although this vesicular rash heals up within a few weeks, pain sometimes continues, becoming postherpetic neuralgia. In the case of those at high risk of developing postherpetic neuralgia, early interventional pain management is generally recommended as a preventive measure. Pain specialists usually do not see patients face-to-face for chronic refractory pain until the stage of postherpetic neuralgia. However, active and aggressive management, including antiviral treatment, of herpetic neuralgia during the acute stage of herpes zoster promises better results. In this respect, superficial cervical plexus block can help patients, such as the case reported here, by relieving the pain of herpes zoster involving the C3 dermatome.Case presentationA 65-year-old Korean man with severe pain in his left C3 dermatome due to herpes zoster was admitted to our hospital. His pain was so refractory to medication that he consulted our pain clinic for pain control. Due to the medication limitations imposed by his underlying diseases (hepatitis B, liver cirrhosis, atrial fibrillation, and asthma), early interventional therapy including stellate ganglion block was planned. In addition, because his painful C3 dermatome overlapped significantly with the superficial cervical plexus dermatome, ultrasound-guided superficial cervical plexus block was utilized for pain control of the intractable herpes zoster neuritis in his C3 dermatome. The result with respect to his sporadic neuralgia was satisfactory.ConclusionsWe found superficial cervical plexus block to be an effective interventional procedure for pain management of herpes zoster, particularly at the C3-dermatomal level.
Highlights
Herpes zoster is a well-known reactivating viral disease that gives rise to painful skin lesions
We found superficial cervical plexus block to be an effective interventional procedure for pain management of herpes zoster, at the C3-dermatomal level
Herpes zoster (HZ) is a disease caused by reactivation of the varicella zoster virus (VZV) after initial presentation as chickenpox under conditions such as old age, malignancy, diabetes, and immunosuppressive therapy with/ without steroids [1,2,3]
Summary
Whereas SGB is an interventional modality that is often employed, instances of its combination with SCP block in the treatment of HZ involving the C3 dermatome are almost unprecedented. We suggest that in cases where patients complain of periauricular pain without lesions or other apparent origin, there is a need to rule out the possibility of prodromal-phase HZ involving the C3 dermatome. On the basis of the results of this case report, we recommend SCP block as a potentially very effective, minimally invasive and ultrasound-guidable treatment option for the control of intractable pain corresponding to the distribution of the SCP. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. HS performed the ultrasound-guided superficial cervical plexus block
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