Evidence for the beneficial effect of epidural LA + steroid in HZ, and intrathecal LA + steroid in PHN appears to be consistent (grade A). If given within 2 months of HZ, epidural LA + steroid may reduce the incidence of PHN after 1 year (grade A). Evidence for use of sympathetic blocks in HZ and PHN, although generally useful (Grade B), requires RCTs for validation.

A 3-year-old child developed extensive macular rash after ketamine. The mechanism of this reaction was investigated by the Prausnitz-Kutzner (P-K) test. It demonstrated that the histamine release was not the result of an anaphylactic reaction, but rather a direct pharmacological effect of the drug. The result suggests that this child can receive ketamine in the future without any severe manifestations. The mechanisms of histamine release are discussed and the treatment of its clinical manifestations is reviewed.

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