Ultrasound vs. Fluoroscopy Guided Erector Spinae Plane Block in Postherpetic Neuralgia: A Prospective Study

Background: The erector spinae plane block (ESPB) is a commonly used interventional method in the treatment of post-herpetic neuralgia (PHN). ESPB can be performed under the guidance of ultrasound or fluoroscopy, and there are limited data in the literature regarding the effectiveness of ESPB using these two imaging modalities on pain. In this study, we aimed to compare the effectiveness of ESPB performed under the guidance of ultrasound and fluoroscopy on pain reduction in PHN. Methods: Patients between the ages of 18 and 90 years with thoracal pain related to PHN and scheduled to undergo the ESPB were enrolled in the prospective observational study. Patients were divided into two groups: those who underwent a single-shot fluoroscopy-guided (FS) or ultrasound-guided (USG) ESPB. The Numeric Rating Scale-NRS was used to assess pain intensity, and the DN-4 questionnaire was used to assess the presence of neuropathic pain (NP). Results: In the final analysis, data from a total of 48 patients, 24 from each group, were evaluated. No statistically significant difference was found between the two groups in terms of demographic data and initial clinical features. While a significant decrease in NRS scores was seen in both groups at the first and third months, no significant difference was seen between the two groups. There was no significant change in the number of patients with NP in either group compared to baseline. Conclusions: Both ultrasonography and fluoroscopy-guided ESPB appear to be effective in reducing pain in PHN. Further studies are needed for the efficacy of ESPB on NP.