title: Home-based patient-controlled epidural analgesia with bupivacaine for patients with intractable herpetic neuralgia.
abstract: This clinical report is based on retrospective observation of the outcome and effects of patient-controlled epidural analgesia (PCEA) with bupivacaine infusion administered at home to five patients with intractable herpetic neuralgia. All patients had severe pain (9 or 10 visual analogue scale [VAS]points) confined to the affected dermatomes, which was refractory to medication. The interval between zoster onset and PCEA application ranged from 27 to 60 days (mean, 37.2 d). The average daily amount of bupivacaine used was 36.5 to 91.2 mg (mean +/- standard deviation, 62.4 +/- 19.7 mg). The duration of PCEA therapy ranged from 10 to 28 days (18.4 +/- 7.6 d). One patient developed drug tolerance. All treatments resulted in effective and satisfactory pain relief (VAS, 0-3), with increase in physical activities to normal levels and easing of sleep and appetite impairment. No deleterious effects were found during PCEA therapy. After discontinuation of PCEA, two patients did not complain of pain but still had slight paresthesia, one of them required low-dose antidepressant for 17 days; three patients continued to have occasional sharp pain (VAS, 2-3) and required low-dose antidepressant and analgesic as-needed for one to six months. These results suggest that PCEA with bupivacaine infusion provides effective pain relief in patients with intractable herpetic neuralgia and is a feasible and effective home treatment modality with limited side effects.
authors.affiliation: Department of Anesthesia, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Y C
authors.initials: YC
authors.lastname: Tsai
authors.forename: L K
authors.initials: LK
authors.lastname: Wang
authors.forename: B S
authors.initials: BS
authors.lastname: Chen
authors.forename: H P
authors.initials: HP
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D005260:Female; D006562:Herpes Zoster / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine