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Relief of pain in acute herpes zoster by nerve blocks and possible prevention of post-herpetic neuralgia

[Le soulagement de la douleur de l’herpès zoster aigu et la prévention possible de la névralgie post-herpétique par des blocages nerveux]

From the Department of Anesthesiology, University of Ottawa, Ottawa, Ontario, Canada.

Address correspondence to: Dr. Douglas Hardy, Department of Anesthesiology, The Ottawa Hospital-Civic Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. Phone: 613-761-4169; Fax: 613-761-5209; E-mail: dhardy{at}ottawahospital.on.ca

Purpose: This report describes two cases of acute herpes zoster (AHZ) treated by nerve block resulting in immediate pain relief and possible prevention of post-herpetic neuralgia (PHN).

Clinical features: Two elderly females with AHZ of cervical dermatomes and severe pain received deep cervical and greater occipital nerve blocks with a local anesthetic, epinephrine and steroid. In both patients, pain resolved immediately and permanently (one year follow-up) after a single treatment.

Case #1: A 79-yr-old female with a mechanical mitral valve and anticoagulated with warfarin presented with AHZ of 17 days duration of the right C2, 3, 4 dermatomes and severe pain. A stellate ganglion block was not performed because of anticoagulation. Rather, a deep cervical root block at C3 and a greater occipital nerve block were performed with bupivacaine, epinephrine and methylprednisolone. No adverse events were evident. Case #2: A 73-yr-old female with a history of osteoarthritis and Meniere’s disease presented with AHZ of seven days duration of the left C2, 3, 4 dermatomes and severe pain. Deep cervical root blocks at C3 and C4 and a greater occipital nerve block were performed with bupivacaine, epinephrine and methylprednisolone. Side effects of dizziness, hoarseness, hypertension and Horner’s syndrome resolved in a few hours. A mild sensation of itching persisted for two weeks.

Conclusion: This report illustrates the potential of nerve blocks in severe AHZ to treat acute pain and possibly prevent PHN.