The Ewha Medical Journal
Ewha Womans University School of Medicine
Original Article

The Efficiency of the Nerve Blocks for Postherpetic Neuralgia: Preliminary Study

Kyu Man Shin, Do Sang Cho, Yong Jae Cho, Myung Hyun Kim, Sang Jin Kim, Sung-Hak Kim

Copyright ⓒ 2005. Ewha Womans University School of Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Published Online: Mar 30, 2005

Abstract

Objectives

Of all the chronic pain syndromes postherpetic neuralgia ranks the most refractory to treatment. The eight postherpetic neuralgia patients have been treated with nerve blocks or neurolysis and obtained good result. We evaluate the therapeutic effect of nerve blocks for postherpetic neuralgia and reviewed the pathology, clinical consideration, treatments and prevention.

Materials and Methods

Eight patients with established postherpetic neuralgia enrolled in pain clinic of Mokdong Hospital of Ewha Womans University from March,2004 to December. Average age at 58 and about 63% of patients were over 68 years. Affected area of forehead was two patients. They have been treated with stellate ganglion block (SCB), two times supraorbital and supratrochlear nerves blocks and neurolysis with absolute alcohol. Face affected patient has was one and has been treated with 5 times SGB, 2 times supraorbital and supratrochlear nerves blocks, infraorbital and mental nerves blocks, and then 2times maxillary and mandibular nerves blocks. Chest affected two patients were treated with intercostal nerve blocks. Thoracic wall affected one patient received 2 times thoracic epidural blocks and thoracic nerve block. Scapalur and thoracic wall affected patient has been treated with SGB and 2 times thoracic epidural block. The chest and thoracic wall affected patient received 10 times intercostal blocks,2 times thoracic epidural blocks,3 times thoracic root block and neurolysis of intercostal nerves with absolute alcohol. The injected agents were 1% mepibacaine or 0.25% mercain heavy and methylprednisolone succinated, and at weekly intervals the agents were injected.

Results

All patient having been treated with nerve blocks were free of pain at 3-9 months.

Conclusion

Although no controlled trial has been done of nerve blocks to treat postherpetic neuralgia, this technique is safe in experienced hands and, if effected, may be repeated. It suggested that local anesthetics and steroid are the effective components in nerve blocks. Data on the relief of acute pain with nerve blocks, however cannot be extrapolated to predict the prevention of postherpetic neuralgia. The best way to prevent herpes zoster becasuse of post herpetic neuralgia is so difficult to treat.

Keywords: Postherpetic neuralgia; Nerves block