Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: A systematic review and meta-analysis

Hyun Jung Kim, Hyeong Sik Ahn, Jae Young Lee, Seong Soo Choi, Yu Seon Cheong, Koo Kwon, Syn Hae Yoon, Jeong Gill Leem

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Background: Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids. Methods: This systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy. Results: Nine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events. Conclusions: Applying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed.

Original languageEnglish
Pages (from-to)3-17
Number of pages15
JournalKorean Journal of Pain
Volume30
Issue number1
DOIs
Publication statusPublished - 2017 Jan 1

Fingerprint

Postherpetic Neuralgia
Nerve Block
Herpes Zoster
Meta-Analysis
Incidence
Central Nervous System Sensitization
Stellate Ganglion
Epidural Injections
Nociceptive Pain
Local Anesthetics
MEDLINE
Libraries
Consensus
Anti-Inflammatory Agents
Language
Randomized Controlled Trials
Steroids
Placebos
Outcome Assessment (Health Care)
Databases

Keywords

  • Epidural block
  • Herpes zoster
  • Nerve block
  • Paravertebral block
  • Postherpetic neuralgia
  • Stellate ganglion block

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster : A systematic review and meta-analysis. / Kim, Hyun Jung; Ahn, Hyeong Sik; Lee, Jae Young; Choi, Seong Soo; Cheong, Yu Seon; Kwon, Koo; Yoon, Syn Hae; Leem, Jeong Gill.

In: Korean Journal of Pain, Vol. 30, No. 1, 01.01.2017, p. 3-17.

Research output: Contribution to journalReview article

Kim, Hyun Jung ; Ahn, Hyeong Sik ; Lee, Jae Young ; Choi, Seong Soo ; Cheong, Yu Seon ; Kwon, Koo ; Yoon, Syn Hae ; Leem, Jeong Gill. / Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster : A systematic review and meta-analysis. In: Korean Journal of Pain. 2017 ; Vol. 30, No. 1. pp. 3-17.
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abstract = "Background: Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids. Methods: This systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy. Results: Nine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events. Conclusions: Applying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed.",
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T1 - Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster

T2 - A systematic review and meta-analysis

AU - Kim, Hyun Jung

AU - Ahn, Hyeong Sik

AU - Lee, Jae Young

AU - Choi, Seong Soo

AU - Cheong, Yu Seon

AU - Kwon, Koo

AU - Yoon, Syn Hae

AU - Leem, Jeong Gill

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N2 - Background: Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids. Methods: This systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy. Results: Nine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events. Conclusions: Applying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed.

AB - Background: Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids. Methods: This systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy. Results: Nine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events. Conclusions: Applying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed.

KW - Epidural block

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KW - Nerve block

KW - Paravertebral block

KW - Postherpetic neuralgia

KW - Stellate ganglion block

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