J Dent Anesth Pain Med.  2015 Dec;15(4):247-249.

Treatment of herpes zoster with ultrasound-guided superficial cervical plexus block

• Lee H
• Jeon Y

Abstract

Herpes zoster most commonly occurs in elderly patients, and usually affects sensory neurons. Therefore, its characteristic symptoms are segmental pain, itching, and sensory changes in the affected areas. A 71-yr-old woman experienced painful herpetic rash on the right cervical 2-4 dermatomes for 16 days. Two days after the onset of the rash, she was diagnosed with herpes zoster, and prescribed 250 mg famciclovir three times a day for 7 days, pregabalin 150 mg twice a day, and tramadol 150 mg once a day for 14 days, by a dermatologist. Despite medication, her pain was rated at an intensity of 6/10 on the numeric rating scale. In addition, she complained of severe itching sensation on the affected dermatomes. Superficial cervical plexus block (SCPB) was performed at the right C4 level with 15 ml 0.5% lidocaine plus triamcinolone 30 mg. Five days after the procedure, pain and itching completely disappeared. SCPB may be an effective option for the treatment of acute pain and itching arising from herpes zoster, and for the prevention of postherpetic neuralgia.

Keyword

Herpes zoster; Itching; Pain; Superficial cervical plexus

MeSH Terms

Acute Pain
Aged
Cervical Plexus Block*
Cervical Plexus*
Exanthema
Female
Herpes Zoster*
Humans
Lidocaine
Neuralgia, Postherpetic
Pregabalin
Pruritus
Sensation
Sensory Receptor Cells
Tramadol
Triamcinolone
Lidocaine
Pregabalin
Tramadol
Triamcinolone

Figure

• 

  Fig. 1 Sixteen days after the onset of herpes zoster. Hyperpigmented macules and crusts are present on the right C2–4 dermatomes.

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  Fig. 2 Ultrasound-guided superfical cervical plexus block. CA; carotid artery, SCM; sternoclavicular muscle. White arrow heads indicate the needle.

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