Optimum pain relief with continuous epidural infusion of local anesthetics shortens the duration of zoster-associated pain.
OBJECTIVE
To investigate effects of continuous epidural infusion (CEI) of 0.5% bupivacaine added to intermittent epidural boluses (IEB) on the duration of zoster-associated pain (ZAP), as compared with continuous infusion of normal saline placebo added to IEB.


METHODS
A prospective, double-blind, randomized, placebo-controlled study.


METHODS
A university hospital and an affiliated clinic in Japan from 1996 through 1999.


METHODS
56 immunocompetent herpes zoster (HZ) patients, 50 years or older, within 10 days of rash onset and with severe pain and eruption.


METHODS
Patients were hospitalized and randomly allocated into 2 groups. CEI group given CEI of 0.5% bupivacaine (0.5-1.0 mL/h) plus IEB of 0.5% bupivacaine 4 times daily (n = 29). IEB group given normal saline infusion plus IEB of 0.5% bupivacaine 4 times daily (n = 27). All patients received oral acyclovir 800 mg, 5 times daily, for 7 days.


METHODS
The number of days required for complete cessation of ZAP and the proportion of subjects with allodynia beyond 30 days.


RESULTS
The median time to cessation of ZAP was significantly shorter in the CEI group than in the IEB group (29 days vs. 40 days, P = 0.002). The number of patients whose allodynia persisted beyond 30 days of treatment was significantly lower in the CEI group than in the IEB group (10% vs. 37%, P = 0.027).


CONCLUSIONS
CEI of 0.5% bupivacaine plus IEB was associated with a shorter duration of ZAP and fewer patients with allodynia beyond 30 days, compared with IEB plus normal saline infusion. Patients at high risk for developing postherpetic neuralgia (PHN) can be managed with intensive therapies at the early stage of disease, such as CEI, which maintains effective analgesia and may reduce the burden of PHN.
Department of Anesthesiology, Kitakyushu Municipal Medical Center, Bashaku, Kokurakita-ku, Japan. hymanabe@mx7.tiki.ne.jp
Haruhiko
H
Manabe
Kenjiro
K
Dan
Kazuhiko
K
Hirata
Koichiro
K
Hori
Shinjiro
S
Shono
Shinichiro
S
Tateshi
Hiroyuki
H
Ishino
Kazuo
K
Higa
D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D003710:Demography; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006562:Herpes Zoster / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000187:drug effects; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000821:virology; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D017193:Skin Diseases, Viral / Q000188:drug therapy / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
D000779:Anesthetics, Local; D002045:Bupivacaine