title: The "three-in-one block" for treatment of pain in a patient with acute herpes zoster infection.
abstract: OBJECTIVE
  Herpes zoster infection in elderly patients frequently results in disabling pain, carries a high risk of postherpetic neuralgia (PHN), and can pose a significant therapeutic challenge.
  
  
  METHODS
  We describe a successful use of the perivascular technique of lumbar plexus blockade ("three-in-one block") for treatment of pain during acute herpes zoster infection in an 82-year-old severely ill patient in whom other modalities were contraindicated.
  
  
  RESULTS
  Three-in-one block using 40 mL of 0.25% bupivacaine with 1:300,000 epinephrine resulted in excellent pain relief that lasted for 2 weeks.
  
  
  CONCLUSIONS
  The perivascular technique of lumbar plexus blockade may be a useful alternative to epidural and paravertebral techniques of lumbar blockade in the occasional patient for whom these other approaches are contraindicated.
authors.affiliation: Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA.
authors.forename: A
authors.initials: A
authors.lastname: Hadzić
authors.forename: J D
authors.initials: JD
authors.lastname: Vloka
authors.forename: G N
authors.initials: GN
authors.lastname: Saff
authors.forename: R
authors.initials: R
authors.lastname: Hertz
authors.forename: D M
authors.initials: DM
authors.lastname: Thys
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D006562:Herpes Zoster / Q000150:complications*; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D009407:Nerve Block; D009437:Neuralgia / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*