The Effect of Erector Spinae Plane Block in Herpes Zoster Patients Who Are Ineffective with Conventional Treatment

Erector Spinae Plane (ESP) Block Application: The block will be performed at the level of the dermatome involved in the thoracic region. If more than one dermatome is involved, the block will be performed at the middle level of the involved area. Patients will be laid in the prone position and skin preparation will be performed with 10% povidone iodine. Cutaneous-subcutaneous anesthesia will be provided with 3 ml of 2% lidocaine hydrochloride at the targeted injection site. Using a linear probe covered with a sterile drape at 8 mHz frequency under ultrasound guidance, the thoracic vertebral spinous process will first be imaged in the horizontal plane in the midline. The probe will then be turned to the longitudinal plane and the transverse process and the erector spinae muscle will be imaged approximately 3 cm lateral from the midline. The 22-gauge, 80-mm block needle will be advanced craniocaudally in-plane and the transverse process will be touched. The needle will then be minimally withdrawn and its location between the erector spinae muscle and the transverse process will be confirmed by hydro-dissection, and 0.375% bupivacaine hydrochloride will be injected in a volume of 20 ml, and the spread of local anesthetic will be visualized simultaneously by ultrasonography. After 30 minutes, loss of hot and cold sensation below and above the level of the blocked dermatome will be considered as a block success. An anaesthetist will be administering the block. The block will be administered for each patient once only. All patients who met the inclusion criteria were started on pregabalin oral tablet treatment at the first application. Patients whose pain could be controlled with appropriate doses of pregabalin treatment and whose Numeric Rating Scale (NRS) score was below 4 formed Group I. Erector spinae plane (ESP) block was performed on patients whose pain could not be controlled with appropriate doses of pregabalin treatment and whose NRS score was 4 and above, and these patients formed Group II. Considering the patients' age, comorbidities, other medications they were using and general conditions, pregabalin treatment was started at a dose of 25 mg twicw daily or 75 mg twice daily, and the patients underwent outpatient clinic check-up 7 days later. Patients with an NRS score below 4 at this check-up continued to use the same dose of medication and were included in Group I. The medication dose of patients with an NRS score of 4 and above was adjusted. The dose of patients using 25 mg twice daily was changed to 75 mg twice daily, and the dose of patients using 75 mg twice daily was changed to 150 mg twice daily, and the patients were called for an outpatient clinic check-up 7 days later. Patients with an NRS score below 4 in this check-up continued to use the same dose of medication and were included in Group I. Patients with an NRS score of 4 and above using 150 mg twice daily pregabalin were included in Group II. The treatment of patients with an NRS score of 4 and above using 75 mg twice daily pregabalin was adjusted to 150 mg twice daily, and an outpatient clinic check-up was performed 7 days later. In this check-up, patients with an NRS score below 4 were included in Group I. Patients with an NRS score of 4 and above were included in Group II. ESP block was performed on the patients in Group II, and the patients were called for an outpatient clinic check-up 1 day later. If the patients' NRS score was still 4 and above at this control, paracetamol and opioid analgesics were added to the treatment. All patients were followed up with a two-week outpatient clinic control and if the NRS score was below 4 at the controls, no change was made in the treatment. If the NRS score was 4 and above, analgesic treatments were arranged. Strong opioids were used at the last stage. If the patient's pain did not respond to this treatment, different interventional methods were planned and these patients were excluded from the study. Again, patients who could not comply with the drugs used due to side effects at any stage of the treatment scheme and whose treatments had to be changed for this reason were also excluded from the study. The last outpatient clinic controls of the patients who responded to the treatment and complied with the treatment were performed at the end of the 3rd month and it was accepted that postherpetic neuralgia (PHN) developed in patients whose pain complaints continued.