Ultrasound-guided Erector Spinae Plane Block for the Management of Herpes Zoster Pain: Observational Study

Abstract

BackgroundHerpes zoster is caused by the reactivation of latent varicella-zoster virus, which promotes acute and chronic pain that may interfere with daily activities and reduce the quality of life. Ultrasound-guided erector spinae plane (ESP) blocks are used for a wide variety of indications in the management of acute, chronic, and postoperative pain. Our aim was to evaluate the efficacy of ultrasound-guided erector spinae plane blocks for the management of pain in herpes zoster.MethodsThe medical records of 34 patients with acute or chronic pain during herpes zoster between May 2017 and June 2018 were investigated at two pain clinic centers. The patients received ultrasound-guided erector spinae plane block: We performed a single injection for the patients having acute pain and a continuous block for the patients having chronic pain. Patient characteristics, block characteristics (needle insertion level, catheter, or single insertion), the volume of given local anesthetics, the intensity of pain before and after the block procedure using a numerical rating score (NRS) between 0 and 10, and the duration of analgesia were evaluated.ResultsAll patients reported a remarkable and rapid resolution of pain immediately after the block procedure. Median (min-max) NRS score before the block procedure was 9 (4-10). The median (min-max) NRS score was 1.5 (0-7) after the block procedure. The difference was found to be statistically significant (p<0.0001). NRS score after the third month was 1 (0-3); the difference is statistically significant (p=0.002). The median value of analgesia time (min-max) was 18 (3-24) hours.ConclusionOur preliminary experience demonstrated that an ESP block provided sufficient analgesia in acute herpetic pain. A combination of ESP block, pregabalin, and tramadol was also effective within the three-months-period after the block performance.

Ultrasound‐guided Erector Spinae Plane Block (US‐ESPB)—Anesthetic block: Case report

“…[1][2][3] From recent literature, it is known that the injection of local anesthetic (LA) into the deep fascial plane to erector spinae muscle (the erector spinae plane, ESP) at the level of the T5 transverse process can produce profound analgesia of the ipsilateral hemithorax. 4,5 Anatomical dissection indicates that the likely action mechanism is the diffusion of LA anteriorly through the connective tissues and ligaments spanning the adjacent transverse processes and into the vicinity of the spinal nerve roots (consistent with other reports of successful analgesia following injection into a similar tissue plane in the thorax 6,7 ).…”

“…From recent literature, it is known that the injection of local anesthetic (LA) into the deep fascial plane to erector spinae muscle (the erector spinae plane, ESP) at the level of the T5 transverse process can produce profound analgesia of the ipsilateral hemithorax 4,5 …”

<p>A Rare Case of Euphoria Caused by Lidocaine After an Erector Spinae Plane Block: A Case Report</p>

“…Although randomized, controlled studies have not been performed yet, the efficacy of ESPB for acute herpes pain has been demonstrated in several studies. 14,15 The mechanism of action is unclear, but it has been reported that the injected local anesthetic spreads through the costotransverse foramen to the external intercostal muscle and internal intercostal membrane, 6 and interfacial injected local anesthetics spread through the costotransverse foramen and peripheral porous tissues to the intercostal and thoracic paravertebral spaces. 16 Additionally, sensitivity depends on the integrity of A-gamma fibers (light touch), A-delta fibers (cold and pinprick), and C fibers (warmth and dull pain).…”

Erector spinae plane block vs non‐steroidal anti‐inflammatory drugs for severe renal colic pain: A pilot clinical feasibility study

“…To conclude, the ultrasound‐guided plane blocks have been included in the multi‐model analgesic concept as a non‐opioid analgesic option 9 . The ultrasound‐guided erector spinae plane (ESP) block, which was first defined with thoracic neuropathic pain management by Forero, 10 is currently routinely used in several surgical procedures for postoperative analgesia, 11,12 and it is also used in the analgesic management of various acute and chronic pain 13,14 . We have shared a presentation of three cases to point out the analgesic efficacy that the ESP block might potentially have in acute renal colic 15 .…”