Ultrasound-Guided Thoracic Paravertebral Block With Steroid and Local Anesthetic for Acute Herpes Zoster: Effects on Pain Control and Prevention of Postherpetic Neuralgia

Assiut University

Status and phase: Completed; Phase 3

Conditions: Postherpetic Neuralgia

Treatments: Drug: Valacyclovir + Paracetamol (Acetaminophen) + Gabapentin (standard medical therapy); Procedure: Ultrasound-guided thoracic paravertebral block (TPVB) with bupivacaine 0.25% + methylprednisolone 40 mg

Study type: Interventional

Funder types: Other

Identifiers

NCT07349680

20260230004

Details and patient eligibility

About

Background: Acute herpes zoster causes severe neuropathic pain and may progress to postherpetic neuralgia (PHN). This study aims to evaluate ultrasound-guided thoracic paravertebral block with local anesthetic and steroid in reducing acute pain and PHN incidence.

Methods: This prospective randomized study included 100 patients diagnosed with acute thoracic herpes zoster (rash ≤14 days, NRS ≥4). Participants were allocated into two groups: a control group receiving standard medical treatment and an intervention group receiving standard treatment in addition to an ultrasound-guided thoracic paravertebral block with (0.25% bupivacaine + 40 mg methylprednisolone) at 48-72-hour intervals. Pain intensity was assessed at baseline and during follow-up. The incidence of postherpetic neuralgia was recorded. Secondary outcomes included analgesic consumption and patient satisfaction.

Enrollment: 100 patients

Sex: All

Ages: 45 to 65 years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

Eligibility Criteria Inclusion Criteria

Age 45-65 years

Diagnosed with acute thoracic herpes zoster

Rash duration ≤ 14 days

Moderate to severe pain, defined as NRS ≥ 4

Total sample size: 100 patients

Exclusion Criteria

Contraindications to thoracic paravertebral block, including:

Coagulopathy

Infection at the injection site

Allergy to local anesthetics or steroids

Immunosuppression or ongoing chemotherapy

Pre-existing chronic pain in the same affected region

Severe cognitive impairment or psychiatric illness preventing reliable pain assessment

Pregnancy or lactation

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

100 participants in 2 patient groups

Standard medical therapy for acute thoracic herpes zoster

Other group

Description:

Participants received standard medical therapy consisting of: Valacyclovir 1000 mg orally three times daily for 7 days Paracetamol (Acetaminophen) 1 g orally twice daily for 14 days Gabapentin starting at 300 mg/day, titrated according to pain intensity and tolerance, up to a maximum of 1800 mg/day

Treatment:

Drug: Valacyclovir + Paracetamol (Acetaminophen) + Gabapentin (standard medical therapy)

Ultrasound-guided thoracic paravertebral block (TPVB) with local anesthetic + corticosteroid

Active Comparator group

Description:

Participants received an ultrasound-guided thoracic paravertebral block (TPVB) using an injectate volume of 15 mL, consisting of: Bupivacaine 0.25% (local anesthetic) Methylprednisolone 40 mg (corticosteroid) The block was performed at the thoracic level corresponding to maximal pain/dermatomal involvement, and was repeated every 48 hours for a total of three sessions.

Treatment:

Procedure: Ultrasound-guided thoracic paravertebral block (TPVB) with bupivacaine 0.25% + methylprednisolone 40 mg

Drug: Valacyclovir + Paracetamol (Acetaminophen) + Gabapentin (standard medical therapy)