Effect of repeated paravertebral injections with local anesthetics and steroids on prevention of post-herpetic neuralgia

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This randomized double blind clinical trial will be carried out at Mansoura University Hospital After approval from the Institutional Ethical Committee and obtaining of written, informed consent, 80 adult patients with acute herpes zoster affecting the chest wall will be referred from the dermatology clinic after prescribing appropriate antiviral therapy (acyclovir 800 mg five times daily administered orally for 7 days within the first 72 hours of eruption). Inclusion criteria: patients over 50 who had chest wall herpetic eruption of less than one week, with moderate and severe pain and received appropriate antiviral therapy. Exclusion criteria includes: patient refusal, eruption of more than one week duration, patients who did not receive appropriate antiviral therapy, patients with mild pain, heavy skin eruption (no healthy area for needle entry) and infection at site of injection. Patients with history of renal, hepatic diseases, coagulopathy, diabetes, steroid therapy, malignancies and patients taking chemo and/or radiotherapy will be excluded. Patients will be randomly assigned using a computer-generated random number assignment to receive paravertebral block using either 25 mg bupivacaine 0.5% plus 8 mg dexamethasone in a total volume of 10 ml twice one week apart under fluoroscopy ( Group 1) or 25 mg bupivacaine 0.5% plus 8 mg dexamethasone in a total volume of 10 ml three times one week apart under fluoroscopy ( Group 2). All patients will receive pregabalin in a dose of 150 mg/ twice with gradual reduction of the dose as the pain controlled. Acetaminophine was available as rescue analgesia in a dose of 1000 mg on request. Patients will be evaluated for pain severity using Visual Analogue Scale (VAS), (10 cm unmarked line in which 0 = no pain and 10 cm=worst pain imaginable) before the block (basal), 1 hour after the block, every 3 days for 2 weeks after the procedure and every week for 6 weeks and after 3 and 6 months. At each assessment visit, the total analgesic consumption will be recorded. The times of complete resolution of pain (from the date of paravertebral block till complete disappearance of herpetic pain) and skin eruption (identified by drop of last crust) will be recorded. The incidence of persistent herpetic pain after 3 and 6 months will be also reported as PHN.

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