Int J Med Sci 2020; 17(12):1811-1818. doi:10.7150/ijms.46038
Efficacy of intermittent epidural dexamethasone bolus for zoster-associated pain beyond the acute phase
Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
Choi EM, Chung MH, Jun JH, Chun EH, Jun IJ, Park JH, Choi Eh, Kim JE. Efficacy of intermittent epidural dexamethasone bolus for zoster-associated pain beyond the acute phase. Int J Med Sci 2020; 17(12):1811-1818. doi:10.7150/ijms.46038. Available from http://www.medsci.org/v17p1811.htm
Herpes zoster develops when latent varicella zoster virus is reactivated in the trigeminal or dorsal root ganglions. Zoster-associated pain (ZAP) is neuropathic pain caused by the herpes zoster virus. Histological studies of postherpetic neuralgia patients suggest that inflammation is involved in ZAP. The effectiveness of local anesthetic and steroid epidural injections in ZAP patients has been reported. However, most studies included patients with acute herpes zoster, and the safety and therapeutic effects of different doses of epidural steroids in ZAP patients remain elusive. In this study, we randomly assigned 42 patients with severe ZAP beyond the acute phase, as determined by a numeric rating scale (NRS) score ≥7, to receive continuous epidural infusion of local anesthetics with either a one-time 5-mg dose or intermittent repeated doses (15 mg total) of dexamethasone. We found that intermittent repeated epidural dexamethasone bolus resulted in reduced NRS scores and an increased likelihood of complete remission in ZAP patients without any adverse effects. Thus, our results suggest that intermittent repeated epidural dexamethasone administration is safe and effective for treatment of ZAP beyond the acute phase.
Keywords: continuous epidural infusion, dexamethasone, epidural, local anesthetics, neuropathic pain, zoster-associated pain