Overview
The aim of this study is to compare the analgesic efficacy and safety of ultrasound-guided midpoint transverse process block versus ultrasound-guided erector spinae plane block in patients suffering from thoracic herpes zoster pain.
Description
Herpes zoster is caused by reactivation of latent varicella-zoster virus in dorsal root or cranial nerve ganglia and commonly presents with unilateral dermatomal rash associated with severe neuropathic pain.
The erector spinae plane block is an ultrasound-guided interfascial plane block in which local anesthetic is deposited deep to the erector spinae muscle adjacent to the transverse process, allowing multidermatomal spread and thoracic analgesia. Recent studies support its efficacy in herpes zoster pain management.
The midpoint transverse process to pleura block is a paravertebral-by-proxy technique where local anesthetic is injected midway between the posterior border of the transverse process and pleura. It may provide thoracic segmental analgesia with lower pleural puncture risk and easier sonoanatomy.
Eligibility
Inclusion Criteria:
- Age 21-60 years.
- Both sexes.
- American Society of Anesthesiologists (ASA) physical status I-II.
- Acute thoracic herpes zoster within 30 days of rash onset.
- Moderate to severe pain \[numeric rating scale (NRS)≥4\].
Exclusion Criteria:
- Refusal to participate.
- Coagulopathy or anticoagulant therapy.
- Infection at puncture site.
- Allergy to study drugs.
- Severe psychiatric illness or inability to assess pain.
- Previous thoracic surgery deformity.
- Uncontrolled Diabetic patient.
- Chronic diseases as renal, hepatic, malignancy.
- Patients with chronic disease need analgesia.
- Patients are coming for more than 3 months (after healing of rash).
