Acute herpes zoster pain is very severe . Conventional analgesics may be of no value. Regional blocks may play a role

Inclusion Criteria:

• Adult population between 30 and 75 years old.
• Unilateral painful thoracic herpetic eruption of less than one week duration.
• VAS more than or equal 4, persistent pain in spite of proper antiviral and analgesic therapy, (800 mg oral acyclovir, 5 times per day, for one week), pregabalin 300 mg per day, acetaminophen 1000 mg per day, topical calamine lotion).

Exclusion Criteria:

• Diabetic patients.
• Painful herpetic eruptive vesicles more than one week.
• Abdominal herpetic eruptions.
• Non-compliant on anti-viral (bulbar palsy for example).
• Co-malignancy or radiotherapy.
• Steroid therapy > 5 mg prednisolone or its equivalent.
• Infections or hematoma at site of injection.
• Coagulopathy (chronic kidney or liver disease, clopidogrel use).