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The role of sympathetic blockade in terminating acute herpes zoster and preventing postherpetic neuralgia
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THE ROLE OF SYMPATHETIC BLOCKADE IN TERMINATING ACUTE HERPES ZOSTER AND PREVENTING POSTHERPETIC NEURALGIA. /I$:"PPF; H. Yanagidal, K. Suwal*and G. Corssen2, Departments of Anesthesiology,The Tokyo Kosei Nenkin Hospital and the University of Tokyo, Tokyo, Ja anland Central Arizona Anesthesiology, Scottsdale, Arizona 85254, USA3 . Aim of Investigation:Since Rosemak in 1938 reported that sympathetic blockade can terminate acute herpes zoster, its effectiveness in the treatment of the disease and in the prevention of postherpeticneuralgia has been confirmed by several clinical investigators.This study examines the question whether sympathetic blockade applied during the period of general malaise and pain prior to manifestation of cutaneous herpetic eruption may yield better results in terminating acute herpes zoster and preventing the development of postherpetic neuralgia as compared to the application of sympathetic blockade after skin eruption. Methods: 45 patients with signs and symptoms of acute herpes zoster received sympathetic blockade prior to skin manifestation (Group A) and 218 patients received sympathetic blockade within 10 days after skin eruption occurred (Group B). Results: In the 45 patients of Group A, 66.7% experienced complete pain relief, 20.0% improved and 13.38 developed postherpetic neuralgia. Of the 218 patients of Group B, complete pain relief was achieved in 71.8$, improvement was recorded in 17.1% and postherpeticneuralgia developed in 11.1% Conclusion: Application of sympathetic blockade prior to or after the the occurrence of herpetic cutaneous skin eruption yields essentially the same results in providing complete or partial pain relief (86.7% versus 88.9% respectively) and in preventing the development of postherpetic neuralgia (13.3% versus 11.1% respectively). The value of sympathetic blockade in the prevention of postherpetic neuralgia may be questioned since only about 10.0% of patients with acute herpes zoster develope postherpetic neuralgia without being subjected to sympathetic blockade. I.V. REGIONAL GUANETHIDINE VS. RESERPINE FOR PAIN RELIEF IN REFLEX SYMPATHETIC DYSTROPHY (RSD); A CONTROLLED, RANDOM- pi IZED, DOUBLE-BLIND, CROSSOVER STUDY. P.A. Lief, R. Reisman A. Rocco, W. McKay, A. Kaul: and K. Benfell: Departments of Anesthesia and Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A., 02115. Aim of Investigation. Either intravenous regional guanethidine or reserpine has been reported as efficacious in the treatment of RSD. However, these medications have not been compared in a double blind fashion. The purpose of this study was to make such a comparison. Method. Twelve patients with RSD for an average of 2.5 years were entznto the study. Eight of the patients failed to obtain long-term pain relief with local anesthetic sympathetic blocks. Each patient received 1-V. regional injection of A) guanethidine 20 mg in 50 ml. -5% lidocaine, B) reserpine 1.25 mg in 50 ml .5% lidocaine, or C) 50 ml plain .5% lidocaine with a one week interval in between each treatment. The injection which afforded the most analgesia was repeated at weekly intervals under double blind conditions until analgesic efficacy demonstrated a plateau. Pain was measured by a numerical analog scale. Follow up occurred for at least 6 months. Results. Both A and B were statistically superior (p&.05) to C in achEa decrease in pain of 50% or more for 48 hours'or longer. No statistical difference in pain relief between A and B was obtained. Patients who responded to A did not-necessarilyrespond to B. Only one patient obtained greater than 50% pain relief for longer than 2 months. This patient received B and has been pain free for longer than one year. Conclusion. Although either guanethidine or reserpine achieved significant pain relief as compared to lidocaine, none of the medications demonstrated statistically significant long-term pain relief.
THE ROLE OF SYMPATHETIC BLOCKADE IN TERMINATING ACUTE HERPES ZOSTER AND PREVENTING POSTHERPETIC NEURALGIA. /I$:"PPF; H. Yanagidal, K. Suwal*and G. Corssen2, Departments of Anesthesiology,The Tokyo Kosei Nenkin Hospital and the University of Tokyo, Tokyo, Ja anland Central Arizona Anesthesiology, Scottsdale, Arizona 85254, USA3 . Aim of Investigation:Since Rosemak in 1938 reported that sympathetic blockade can terminate acute herpes zoster, its effectiveness in the treatment of the disease and in the prevention of postherpeticneuralgia has been confirmed by several clinical investigators.This study examines the question whether sympathetic blockade applied during the period of general malaise and pain prior to manifestation of cutaneous herpetic eruption may yield better results in terminating acute herpes zoster and preventing the development of postherpetic neuralgia as compared to the application of sympathetic blockade after skin eruption. Methods: 45 patients with signs and symptoms of acute herpes zoster received sympathetic blockade prior to skin manifestation (Group A) and 218 patients received sympathetic blockade within 10 days after skin eruption occurred (Group B). Results: In the 45 patients of Group A, 66.7% experienced complete pain relief, 20.0% improved and 13.38 developed postherpetic neuralgia. Of the 218 patients of Group B, complete pain relief was achieved in 71.8$, improvement was recorded in 17.1% and postherpeticneuralgia developed in 11.1% Conclusion: Application of sympathetic blockade prior to or after the the occurrence of herpetic cutaneous skin eruption yields essentially the same results in providing complete or partial pain relief (86.7% versus 88.9% respectively) and in preventing the development of postherpetic neuralgia (13.3% versus 11.1% respectively). The value of sympathetic blockade in the prevention of postherpetic neuralgia may be questioned since only about 10.0% of patients with acute herpes zoster develope postherpetic neuralgia without being subjected to sympathetic blockade. I.V. REGIONAL GUANETHIDINE VS. RESERPINE FOR PAIN RELIEF IN REFLEX SYMPATHETIC DYSTROPHY (RSD); A CONTROLLED, RANDOM- pi IZED, DOUBLE-BLIND, CROSSOVER STUDY. P.A. Lief, R. Reisman A. Rocco, W. McKay, A. Kaul: and K. Benfell: Departments of Anesthesia and Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A., 02115. Aim of Investigation. Either intravenous regional guanethidine or reserpine has been reported as efficacious in the treatment of RSD. However, these medications have not been compared in a double blind fashion. The purpose of this study was to make such a comparison. Method. Twelve patients with RSD for an average of 2.5 years were entznto the study. Eight of the patients failed to obtain long-term pain relief with local anesthetic sympathetic blocks. Each patient received 1-V. regional injection of A) guanethidine 20 mg in 50 ml. -5% lidocaine, B) reserpine 1.25 mg in 50 ml .5% lidocaine, or C) 50 ml plain .5% lidocaine with a one week interval in between each treatment. The injection which afforded the most analgesia was repeated at weekly intervals under double blind conditions until analgesic efficacy demonstrated a plateau. Pain was measured by a numerical analog scale. Follow up occurred for at least 6 months. Results. Both A and B were statistically superior (p&.05) to C in achEa decrease in pain of 50% or more for 48 hours'or longer. No statistical difference in pain relief between A and B was obtained. Patients who responded to A did not-necessarilyrespond to B. Only one patient obtained greater than 50% pain relief for longer than 2 months. This patient received B and has been pain free for longer than one year. Conclusion. Although either guanethidine or reserpine achieved significant pain relief as compared to lidocaine, none of the medications demonstrated statistically significant long-term pain relief.