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Canadian Journal of Anesthesia

, Volume 52, Issue 2, pp 186–190 | Cite as

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

  • Douglas HardyEmail author
Regional anesthesia and pain

Abstract

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.

Keywords

Bupivacaine Herpes Zoster Nerve Block Postherpetic Neuralgia Famciclovir 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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

Résumé

Objectif

Décrire deux cas d’herpès zoster aigu (HZA) traités par blocage nerveux résultant en un soulagement immédiat de la douleur et une prévention possible de la névralgie post-herpétique (NPH).

Éléments cliniques

Deux femmes âgées souffrant d’HZA des dermatomes cervicaux et de douleurs sévères ont reçu un bloc des nerfs cervical profond et grand occipital avec un anesthésique local, de l’épinéphrine et des stéroïdes. Dans les deux cas, la douleur a été soulagée de façon immédiate et permanente comme l’a montré le suivi d’un an.

Cas no 1

Une femme de 79 ans, porteuse d’une valvule mitrale mécanique, anticoagulée avec de la warfarine, souffrait depuis 17 jours d’un HZA au niveau des dermatomes droits C2, 3, 4 et de sévères douleurs. L’anticoagulation ne permettant pas de bloc du ganglion stellaire, on a plutôt opté pour un bloc de la racine cervicale profonde à C3 et un bloc du grand nerf occipital avec de la bupivacaïne, de l’épinéphrine et de la méthylprednisolone. Aucune évidence d’événement indésirable n’a été notée. Cas no 2: Une femme de 73 ans aux antécédents d’ostéoarthrite et de maladie de Ménière, a consulté pour un HZA installé depuis sept jours aux dermatomes gauches C2, 3, 4 et pour de sévères douleurs. Des blocs de la racine cervicale profonde à C3 et C4 et un bloc du grand nerf occipital ont été réalisés avec de la bupivacaïne, de l’épinéphrine et de la méthylprednisolone. Les effets secondaires, étourdissement, enrouement de la voix, hypertension et syndrome de Claude Bernard-Horner, se sont résorbés en quelques heures. Une légère sensation de prurit a persisté pendant deux semaines.

Conclusion

Cet article illustre le potentiel des blocages nerveux dans des cas d’HZA sévère pour traiter la douleur aiguë et possiblement prévenir la NPH.

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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  1. 1.Department of AnesthesiologyThe Ottawa Hospital-Civic CampusOttawaCanada

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