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.
Department of Anesthesiology, School of Medicine, Fukuoka University, Japan.
H
H
Manabe
K
K
Dan
K
K
Higa
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