Herpes zoster (HZ) is characterized by a unilateral dermatomal vesicular rash and severe
discomfort along the affected dermatome. It is often caused by the reactivation of
previously latent varicella zoster viruses (VZV) in cases of impaired cellular immunity.
According to recent population-based research , the overall incidence of HZ is almost
6.64/1000 person-years in the population aged 50 years or over, and it rises with age.
The most prevalent and severe side effect of HZ is post-herpetic neuralgia (PHN), which
is commonly described as pain that lasts for 90 days after the rash first appears.
Age-related increases in PHN incidence range from 5 to 30%, with patients over 50 having
a higher risk if they have severe acute pain, a rash with many lesions, or strong
prodromal symptoms.
Regretfully, there hasn't been a treatment that consistently reduces PHN discomfort up
until now. Data from much research showed that patients may have significant clinical and
financial burdens as a result of HZ and its consequences.
Analgesics are typically also needed, even though the availability of antiviral
medications can speed up the end of viral shedding and quicken the healing of rash.
Furthermore, it has no discernible effect on the development of PHN. As a result, it is
crucial to start a methodical treatment plan that might have a preventative impact on
PHN. It has been demonstrated that paravertebral nerve block is effective in treating
acute pain in HZ patients, and it appears to have a greater antiviral treatment-induced
reduction in PHN incidence.
Thoracic paravertebral block ( TPVB) involves the injection of local anesthetics and
steroids adjacent to the thoracic vertebrae, resulting in the blockade of spinal nerves.
This technique can provide segmental anesthesia and prolonged pain relief, making it a
valuable tool in the anesthesiologist's repertoire. While TPVB is commonly used for
postoperative analgesia in thoracic surgery, its application in managing herpetic
neuralgia pain is relatively underexplored as the most recent evidence was published in
2023. Despite the potential benefits of TPVB in treating herpetic neuralgia, there is
limited understanding of the factors that predict its success. Identifying these
predictors could optimize patient selection and improve outcomes, but current literature
on this topic is sparse.
