Korean J Anesthesiol.  1980 Dec;13(4):443-447.

Pain Control of Herpes Zoster by the Epidural Block with small dose of Morphine

• Kim SI
• Kim SJ
• Chun YA
• Park W
• Kim SY

Abstract

Herpes zoster is characterized by multiple grouped erythematous vesicular eruption on the skin with severe pain. Therefore diagnasis of herpes zoster is clinically easy but effective control of its severe pain is not clear yet. Recently, Behar suggested that morphine which was injected into the epidural space reached subarachnoid space and produced potent analgesic effect by direct action on the specific opiate receptors in the substantia gelatinosa of the posterior horn cell of the spinal cord. On the basis suggestion, we have attempted to treat the severe pain of herpes zoster which was developed on right shoulder, right upper anterior and posterior chest, and posterior auricular area. At the initial block, we inserted the catheter into the 6th cervical intervertebral space and the tip of the catheter was placed in epidural space to 3cm cephalad. Then 3mg of morphine mixed with 10ml of normal saline was adminietered and also right stellate ganglion block with 0. 25% bupivacaine 7ml was combined, therefore effective pain relief was obtained for 11 hours. At second block, additional dose of 2mg of morphine mixed with 10ml of normal saline was administered through the inserted epidural catheter at the initial block without stellate ganglion block, and effective pain relief was obtained for 15 hours. After then, whenever the pain was developed, additional dose of 2mg of morphine was administered as the same procedure of the second block, and the duration of pain relief was extended gradually by the each procedure (for 24 hours after third block and for 49 hours after fourth block). At 5 days after initial block, severe pain was completely subsided. Side effects such as postural hypotension, motor weakness and dizziness was not developed except slightly motor weakness after initial block. This result showed that small dose of morphine injection into the epidural space is effective control of severe pain of herpes zoster.

MeSH Terms

Bupivacaine
Catheters
Dizziness
Epidural Space
Herpes Zoster*
Hypotension, Orthostatic
Morphine*
Posterior Horn Cells
Receptors, Opioid
Shoulder
Skin
Spinal Cord
Stellate Ganglion
Subarachnoid Space
Substantia Gelatinosa
Thorax
Bupivacaine
Morphine
Receptors, Opioid