Ultrasound-Guided Thoracic Paravertebral Block With Steroid and Local Anesthetic for Acute Herpes Zoster: Effects on Pain Control and Prevention of Postherpetic Neuralgia: A Randomized Controlled Trial
Ultrasound-Guided Thoracic Paravertebral Block With Steroid and Local Anesthetic for Acute Herpes Zoster: Effects on Pain Control and Prevention of Postherpetic Neuralgia: A Randomized Controlled Trial
Background: Acute herpes zoster causes severe neuropathic pain and may progress to postherpetic neuralgia (PHN). This study aims to evaluate ultrasound-guided thoracic paravertebral block with local anesthetic and steroid in reducing acute pain and PHN incidence.
Methods: This prospective randomized study included 100 patients diagnosed with acute thoracic herpes zoster (rash ≤14 days, NRS ≥4). Participants were allocated into two groups: a control group receiving standard medical treatment and an intervention group receiving standard treatment in addition to an ultrasound-guided thoracic paravertebral block with (0.25% bupivacaine + 40 mg methylprednisolone) at 48-72-hour intervals. Pain intensity was assessed at baseline and during follow-up. The incidence of postherpetic neuralgia was recorded. Secondary outcomes included analgesic consumption and patient satisfaction.
Eligibility Criteria Inclusion Criteria
Age 45-65 years
Diagnosed with acute thoracic herpes zoster
Rash duration ≤ 14 days
Moderate to severe pain, defined as NRS ≥ 4
Total sample size: 100 patients
Exclusion Criteria
Contraindications to thoracic paravertebral block, including:
Coagulopathy
Infection at the injection site
Allergy to local anesthetics or steroids
Immunosuppression or ongoing chemotherapy
Pre-existing chronic pain in the same affected region
Severe cognitive impairment or psychiatric illness preventing reliable pain assessment
Pregnancy or lactation