Herpes Zoster Essay

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Serratus anterior plane (SAP) block for Acute Thoracic Herpes Zoster: Introduction: The concomitant inflammation of the peripheral nerve and skin damage is supposed to be responsible for the acute pain in patients with herpes zoster (HZ). The area affected by the disease can be extremely painful, and pain tends to be exacerbated by any movement or contact. Epidural, intrathecal, and sympathetic nerve blocks have been used in the treatment of pain caused by HZ and postherpetic neuralgia. The recently described pectoral nerve (Pecs) and serratus anterior plane (SAP) blocks are easy and reliable methods for thoracic wall block. The SAP block primarily the thoracic intercostal nerves and to provide anterior hemithorax as arising from the anterior axillary line to the sternum, the posterior hemithorax as being from the posterior axillary line to the spinous processes of the vertebra, and the lateral hemithorax as the area in between the other two. Here we describe the use of ultrasound (US)-guided SAP block to treat acute, severe zoster-associated…show more content…
Localization of the pain was consistent from the T4 to T5dermatome (on the right anterior, lateral and posterior chest wall). He described the pain as severe stabbing and lancinating with a numeric rating scale (NRS) of 8/10. The patient also reported sleep disturbances due to the pain, which had begun 20 day earlier but had aggravated within the last 1 week. He had a 3-year history of taking anticoagulants for the management of arterial fibrillation. At our pain clinic we prescribed tramadol and low dose pregabalin, but they failed to provide pain relief. The anticoagulants contraindicated a possible epidural or paravertebral block because of unwanted and potentialy catastrophic associated sideeffect. Thus, we determined the patient was a good candidate for US-guided SAP

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