Ultrasound-Guided Selective Thoracic Nerve Root Block Combined with Continuous Erector Spinae Plane Block for...

Both selective nerve root blocks and erector spinae plane blocks are common regional blocks in clinical practice, and they have both been shown to relieve acute and chronic pain from herpes zoster. Although selective nerve root block (SNRB) may be the theoretically most effective method of drug delivery to the DRG and requires only a small dose of drug with few complications associated with it, it does not provide effective analgesia for a prolonged period of time. However, continuous erector spinae plane block is considered to be one of the most promising minimally invasive means of analgesia that not only provides prolonged analgesia but is simple to perform, has fewer complications, and facilitates indwelling catheters. In this case report, we describe the possible synergistic mechanism of action of SNRB, continuous erector spinae plane block, and effective relief of postherpetic neuralgia with improved patient outcome.

In this case report, we present the case of an 81-year-old woman with comorbidities including diabetes mellitus, hypertension, and a history of multiple surgeries. She suffered from postherpetic herpes zoster pain in her left thoracic back. Despite trying various treatments such as antiviral medication, physical therapy, traditional Chinese medicine, and a single thoracic paraspinal nerve block, the pain persisted. In consultation with her anesthesiologist, the patient opted for a nerve root block combined with a continuous erector spinae plane block. The erector spinae plane catheter was removed after 14 consecutive days of infusion, although hemolytic Staphylococcus was found in the wound secretions sent for examination, antibiotic treatment was not required. At the 2-year follow-up, the patient remained free of pain recurrence.

Selective nerve root block combined with continuous erector spinae plane block relieves herpes zoster acute phase pain and herpes zoster neuralgia and improves patients' quality of life.