Efficacy of continuous epidural block with epidural electrical stimulation compared to conventional continuous epidural block for acute herpes zoster management: A retrospective study

Abstract

Background Continuous epidural block is commonly used in clinical settings and reduces the likelihood of transition to postherpetic neuralgia via pain control. The purpose of the present study was to compare the efficacies of conventional continuous epidural block and continuous epidural block involving electric stimulation-guided localization of the catheter to areas with neurological damage, in the treatment of herpes zoster pain and prevention of postherpetic neuralgia.Methods We analyzed the medical records of 114 patients in the present study. The patients were divided into two groups: esopocan (conventional continuous epidural block) and epistim (continuous epidural block with epidural electric stimulation). In the esopocan group, the position of the epidural catheter was confirmed using contrast medium alone, whereas in the epistim group, the site of herpes zoster infection was identified through electric stimulation using the guidewire in the catheter. Clinical efficacy was assessed using a numerical rating scale (pain score) up to 6 months after the procedures. We compared the percentage of patients who showed complete remission (pain score less than 2 and no further medication) in each group. We also investigated whether the patients required additional interventional treatment due to insufficient pain control during the 6 month follow-up period after each procedure.Results After adjusting for confounding variables, the pain score was significantly lower in the epistim group than in the esopocan group for 6 months after the procedure. The adjusted odds ratio of patients included in the complete remission category was 1.9 times higher in the epistim group than the esopocan group (95% confidence interval: 0.81-4.44, P = 0.14). The adjusted odds ratio for other interventions within 6 months after the procedure was 3.62 times higher in the esopocan group than the epistim group (95% confidence interval: 1.17-11.19, P = 0.03). Conclusion Epidural drug administration to specific spinal segments using electrical stimulation catheters may be more helpful than conventional continuous epidural block in improving pain and preventing postherpetic neuralgia in acute herpes zoster.