Paravertebral and Erector Spinae Blocks Effective in Preventing Postherpetic Neuralgia, claims study

PHN, a debilitating complication of herpes zoster, is characterized by persistent neuropathic pain following the resolution of the acute rash. Conventional treatments often provide inadequate relief, prompting the exploration of alternative interventions such as regional nerve blocks like PVB and ESPB.

In a prospective randomized controlled study, 60 patients with AHZ-related pain were enrolled and assigned to three groups: Control (standard treatment), PVB (standard treatment with PVB), and ESPB (standard treatment with ESPB). Efficacy was assessed at 15, 30, and 60 days post-treatment, with the primary endpoint being the proportion of patients experiencing adequate pain relief and allodynia resolution.

The key findings of the study were as follows:

• Incidence of PHN post-study: 45% in the ESPB group, 40% in the PVB group, and 80% in the control group (p = 0.022).

• Proportion of patients with pain relief: higher in the PVB group compared to the ESPB group (not statistically significant, p = 0.749).

• Mean pain score on day 60: 2.45 (±3.05) in the ESPB group, 2.15 (±2.7) in the PVB group, and 4.3 (±2.27) in the control group (p = 0.003).

Both PVB and ESPB demonstrated effectiveness in treating AHZ-related pain and preventing its progression to PHN. While the incidence of PHN was lower in both block groups compared to standard treatment alone, the PVB group showed a trend towards superior pain relief.

Paravertebral and erector spinae blocks are promising interventions for managing AHZ-related pain and reducing the risk of developing PHN. These findings suggest that incorporating regional nerve blocks into the treatment regimen may improve outcomes for patients with AHZ. Further research is warranted to validate these results and optimize the use of PVB and ESPB in clinical practice.

Reference:

Patil, A., Vyshnavi, S., Raja, T., Shastry, V., Thammaiah, S. H., & Archana, K. N. (2024). A Randomized clinical trial comparing the efficacy of ultrasound-guided erector spinae block and paravertebral block in preventing postherpetic neuralgia in patients with zoster-associated pain. Journal of Anaesthesiology, Clinical Pharmacology, 10.4103/joacp.joacp_82_23. https://doi.org/10.4103/joacp.joacp_82_23