Continuous epidural infusion of local anesthetics and shorter duration of acute zoster-associated pain.
OBJECTIVE
The purpose of this study was to investigate the effects of continuous epidural blockade on acute zoster-associated pain, compared with intermittent epidural blocks.


METHODS
The design was a retrospective, nonrandomized study.


METHODS
The study was conducted at a university hospital in Japan from 1982 through 1992.


METHODS
A total of 178 otherwise healthy patients hospitalized with moderate or severe herpes zoster lesions.


METHODS
Group A (n = 66) had intermittent epidural blocks using 1% mepivacaine, 4-6 ml, three to six time daily; group B (n = 43) were given intermittent epidural blocks and parenteral acyclovir (500 mg/day) or vidarabine (600 mg/day) for 5 days; group C (n = 69) were administered a continuous epidural 0.5% bupivacaine infusion (0.3-1.0 ml/h) for approximately 2 weeks and antiviral agents followed by intermittent blocks.


METHODS
The number of treatment days was used as the outcome measure.


RESULTS
The length of treatment was significantly shorter in group C than in groups A or B. For moderate lesions the means (days) were 36.2 [95% confidence interval (CI), 31.4-41.7), 45.6 (95% CI, 34.0-61.4), and 26.8 (95% CI, 22.3-32.3) for groups A, B, and C, respectively (p < 0.01). For severe lesions they were 73.3 (95% CI, 55.1-97.7), 81.7 (95% CI, 59.1-113.0), and 44.9 (95% CI, 35.2-57.3) for groups A, B, and C, respectively (p < 0.01).


CONCLUSIONS
Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment and may reduce the incidence of postherpetic neuralgia.
Manabe
H
H
Department of Anesthesiology, School of Medicine, Fukuoka University, Japan.
Dan
K
K
Higa
K
K
D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000998:Antiviral Agents / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006562:Herpes Zoster / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006563:Herpes Zoster Ophthalmicus / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000517:prevention & control; D010146:Pain / Q000503:physiopathology; D010147:Pain Measurement; D010166:Palliative Care; D012189:Retrospective Studies; D013997:Time Factors
D000779:Anesthetics, Local; D000998:Antiviral Agents