Multimodal Nerve Block and Pulse Radiofrequency for Acute Herpes Zoster Pain

Summary

The primary objective of this clinical trial is to evaluate the efficacy of liposomal bupivacaine and ropivacaine in the treatment of pain associated with herpes zoster (shingles). This trial will also assess the safety profiles of both liposomal bupivacaine and ropivacaine. The study aims to address the following key questions: Does nerve blockade with liposomal bupivacaine or ropivacaine reduce the required dosage of gabapentin in participants? What medical issues, if any, arise in participants undergoing paravertebral block, intercostal nerve block, RISS (Radiofrequency Intervention for Spinal Segment); or pulsed radiofrequency (PRF)? Can nerve blocks, specifically paravertebral block, intercostal nerve block, RISS; and PRF, effectively treat severe postherpetic neuralgia (PHN)? The study will compare these interventions. Study Procedures: Participants will:Receive ultrasound-guided nerve blocks or pulsed radiofrequency every 48 hours, for a total of 3 treatments. Undergo assessments, either in-person or via telephone, at the following time points: before therapy (baseline), on the day of treatment (Day 1), Day 7, Day 30, and Day 90 post-treatment. Have their symptoms recorded, along with their scores on the Numerical Rating Scale (NRS) and the Zoster Brief Pain Inventory (ZBPI).

Timeline

Start

2025-02-01

Primary completion

2025-06-01

Completion

2025-06-10

Publications

• Background Russo M, Graham B, Santarelli DM. Gabapentin-Friend or foe? Pain Pract. 2023 Jan;23(1):63-69. doi: 10.1111/papr.13165. Epub 2022 Oct 27.
• Background Elhouty MG, Elbahrawy K, Elawady MS. Rhomboid intercostal block versus serratus block for postoperative analgesia after thoracoscopic sympathectomy for primary palmar hyperhidrosis: a randomized controlled trial. BMC Anesthesiol. 2023 Jul 19;23(1):241. doi: 10.1186/s12871-023-02203-z.
• Background Rosamilia LL. Herpes Zoster Presentation, Management, and Prevention: A Modern Case-Based Review. Am J Clin Dermatol. 2020 Feb;21(1):97-107. doi: 10.1007/s40257-019-00483-1.
• Background Asada H. Recent topics in the management of herpes zoster. J Dermatol. 2023 Mar;50(3):305-310. doi: 10.1111/1346-8138.16666. Epub 2022 Dec 20.
• Background Okmen K, Gurbuz H, Ozkan H. Application of unilateral rhomboid intercostal and subserratus plane block for analgesia after laparoscopic cholecystectomy: a quasi-experimental study. Korean J Anesthesiol. 2022 Feb;75(1):79-85. doi: 10.4097/kja.21229. Epub 2021 Jul 20.
• Background Wang X, Turner EL, Li F. Designing individually randomized group treatment trials with repeated outcome measurements using generalized estimating equations. Stat Med. 2024 Jan 30;43(2):358-378. doi: 10.1002/sim.9966. Epub 2023 Nov 27.
• Background Patil A, Goldust M, Wollina U. Herpes zoster: A Review of Clinical Manifestations and Management. Viruses. 2022 Jan 19;14(2):192. doi: 10.3390/v14020192.
• Background Li SJ, Feng D. Comparison of two distinct needle tip positions in pulsed radiofrequency for herpes zoster-related pain. CNS Neurosci Ther. 2023 Jul;29(7):1881-1888. doi: 10.1111/cns.14146. Epub 2023 Mar 7.
• Background Boezaart AP, Lucas SD, Elliott CE. Paravertebral block: cervical, thoracic, lumbar, and sacral. Curr Opin Anaesthesiol. 2009 Oct;22(5):637-43. doi: 10.1097/ACO.0b013e32832f3277.
• Background Xue M, Yuan R, Yang Y, Qin Z, Fu R. Application of ultrasound-guided thoracic paravertebral block or intercostal nerve block for acute herpes zoster and prevention of post-herpetic neuralgia: A case-control retrospective trial. Scand J Pain. 2024 Jul 9;24(1). doi: 10.1515/sjpain-2024-0030. eCollection 2024 Jan 1.

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