Clinical Study Of Stellate Ganglion Block Treatment For Head And Neck Herpes Zoster

Background It was reported that the incidence of postherpetic neuralgia (PHN) is reached up to 25% among those over the age of 50 years treated with antiviral medication. The role of sympathetic block in relieving the acute pain of herpes zoster (HZ) and reducing the incidence of PHN are still controversial.Objectives The aim of this study is to determine whether early ultrasound-guided stellate ganglion block (SGB) for head and neck acute herpes zoster will reduce the intensity and duration of acute herpetic pain, and if the blockade has the potential to prevent or reduce the incidence and/or severity of PHN.Methods sixty four cases over 50 years were randomly divided to receive a SGB using either lidocaine 0.5%(group L) or saline(group S) and lmg vitamin B12 in a total volume of 5 mL. SGB were completed under ultrasound-guided, twice a week. All patients received Gabapentin 1200mg/d orally, if reduced to mild pain, then gradually reduced to daily doses of 600mg. Tramadol Hydrochloride Sustained-release Tablets was available as needed for 50-100mg twice daily with maximum doses of 400mg/d. Pain assessment using the visual analog scale (vas) and amount of analgesic being taken was measured at the initial visit (basal), weekly for 6 weeks after the procedure and after 2 and 3 months. The time of complete resolution of pain and incidence of PHN was reported. Each patient’s satisfaction and adverse reactions was evaluated.Results There was no significant differences in the demographic characteristics between the two groups. Compared with Group S, There was a significantly shorter duration of pain (P=0.004) and lower VAS scores (P<0.05) noticed during each time period in Group L. In Group L, There was a significantly lower incidence of PHN was encountered (P=0.034) and more patient satisfaction was reported (P=0.044) after 3 months. In addition, The total consumption of Gabapentin and Tramadol was significantly reduced in Group L compared with Group S. No serious adverse effects were reported during the study period, and the incidence of adverse effects was without statistical significance.Conclusions Early ultrasound-guided SGB combined with antiviral agent and gabapentin is a safe and effective treatment modality for head and neck HZ and PHN. It dramatically decreases the intensity of acute pain, shortens its duration, reduces the incidence of PHN and increases patient satisfaction, worthy of clinical promotion.