Single Paravertebral Injection for Acute Thoracic Herpes Zoster: A Randomized Controlled Trial

Makharita, Mohamed Y.; Amr, Yasser Mohamed; El-Bayoumy, Youssef

doi:10.1111/papr.12179

Cited by 45 publications

(65 citation statements)

References 41 publications

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“…Table 1 summarizes the country that conducted each relevant study, inclusion/exclusion criteria, interventions, outcome measures, and results of the included studies [282930313233343536]. All included trials are randomized controlled parallel studies, except one [28]; however, we included this trial in this review because there were no differences in the demographic characteristics and the study participants were consecutively assigned.…”

Section: Resultsmentioning

confidence: 99%

“…Sample sizes ranged between 20-598 patients. There were no differences in the sex ratios between the control and neural block groups mentioned in 8 trials [2829303133343536]. Six trials [293233343536] stated explicit age criteria for inclusion.…”

Section: Resultsmentioning

confidence: 99%

“…There were no differences in the sex ratios between the control and neural block groups mentioned in 8 trials [2829303133343536]. Six trials [293233343536] stated explicit age criteria for inclusion. Among these, 4 trials [29333436] included participants > 50 years old, 1 trial included patients > 55 years [35], and 1 trial included patients > 60 years [32].…”

Section: Resultsmentioning

confidence: 99%

“…Six trials [293233343536] stated explicit age criteria for inclusion. Among these, 4 trials [29333436] included participants > 50 years old, 1 trial included patients > 55 years [35], and 1 trial included patients > 60 years [32]. Three trials [283031] were conducted in Korea and did not state the age criteria, but the mean age of participants was > 56 years in all 3 trials.…”

Section: Resultsmentioning

confidence: 99%

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Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis

et al. 2016

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BackgroundPostherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids.MethodsThis systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy.ResultsNine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events.ConclusionsApplying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis

et al. 2016

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“…Significantly lower doses of pregabalin and acetaminophen were consumed in the active group. Incidence of postherpetic neuralgia was comparable in both groups after 3 months but significantly lower at 6 months [25]. A recent case report also describes the use of neurolytic paravertebral block for intractable cancer pain affecting ribs.…”

Section: Thoracic Paravertebral Blocks For Acute and Chronic Nonsurgimentioning

confidence: 88%

Update on paravertebral blocks

Wardhan¹

2015

Current Opinion in Anaesthesiology

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Effect of Ultrasound‐Guided Intercostal Nerve Block Versus Fluoroscopy‐Guided Epidural Nerve Block in Patients With Thoracic Herpes Zoster: A Comparative Study

Lee

Park

Moon

et al. 2018

J of Ultrasound Medicine

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Objectives To compare the efficacy of a conventional fluoroscopy‐guided epidural nerve block and an ultrasound (US)‐guided intercostal nerve block in patients with thoracic herpes zoster (HZ). Methods This work was a comparative study of 38 patients with thoracic HZ pain and a chest wall herpetic eruption, aged 18 years or older, with pain intensity of 5 or greater on a numeric rating scale (NRS) for less than a 1‐month duration. Patients were consecutively enrolled and assigned to 2 groups in which the intervention was either the US‐guided intercostal nerve block or the fluoroscopy‐guided epidural nerve block approach with the addition of a 5‐mL mix of 2.5 mg of dexamethasone plus 0.5% lidocaine. The primary outcome measure was the NRS score reduction for the pain. Secondary outcomes included the duration of treatment, number of repeated injections until the final visit, and proportion of patients with pain relief after the first and final visits. Results All patients within both intervention groups showed significant pain relief on the NRS at the final follow‐up point (P < .05). There was no significant difference in the mean value of NRS improvement based on the intervention type. There was also no statistically significant difference in the duration of treatment and the frequency of injection for pain relief. Conclusions These findings showed that both the US‐guided intercostal nerve block and the fluoroscopy‐guided epidural nerve block were effective in patients with thoracic HZ. Compared data showed no significant differences in the pain reduction, duration of treatment, and frequency of injection. The US‐guided intercostal nerve block, which is more accessible than the fluoroscopy‐guided epidural nerve block, might be an alternative option for thoracic HZ.

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Single Paravertebral Injection for Acute Thoracic Herpes Zoster: A Randomized Controlled Trial

Abstract: Early single paravertebral blockade in the course of acute thoracic HZ seems to be a safe and effective adjuvant treatment modality.

Cited by 45 publications

References 41 publications

Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis

Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis

Update on paravertebral blocks

Effect of Ultrasound‐Guided Intercostal Nerve Block Versus Fluoroscopy‐Guided Epidural Nerve Block in Patients With Thoracic Herpes Zoster: A Comparative Study

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