Pecs II block for intractable postherpetic neuralgia

Pecs II block for intractable postherpetic neuralgia Journal of Anesthesia (2018) 32:460 https://doi.org/10.1007/s00540-018-2496-6 LE T TER TO  THE   EDITOR Dae Seok Oh Received: 2 February 2018 / Accepted: 12 April 2018 / Published online: 25 April 2018 © Japanese Society of Anesthesiologists 2018 To the Editor: had diminished gradually, and the localized allodynia with a numeric rating scale of 7/10 around the nipple remained. The peripheral and central pathophysiological mechanisms We performed US-guided Pecs II block with 20 ml of 0.2% contribute to postherpetic neuralgia (PHN). A peripheral ropivacaine. His pain relief scale was at a 70–80% reduction nerve block may be used as an alternative option with which after the procedure. This symptom relief was maintained to treat localized peripheral neuralgia, as irritable periph- continuously following repeated blocks which were con- eral nociceptors are responsible for the spontaneous pain ducted at 3–4 days intervals. We suggest that the US-guided and allodynia [1]. We read with interest the article by Kim Pecs II block can be considered as an alternative option, not YD et al. suggested the clinical usefulness of US-guided only for cases in which neuroaxial blocks were contraindi- Pecs II blocks with which to treat PHN in patients for cated, but also, for an localized anterior chest wall pain asso- whom a neuroaxial block was contraindicated due to tak- ciated with PHN that was refractory to neuroaxial blocks. ing anticoagulants [2]. In addition, we report a patient with a localized intractable thoracic PHN who did not respond to various treatments, but in whom the US-guided Pecs II References block induced symptoms improvement. An 82-year-old man 1. Fields HL, Rowbotham M, Baron R. Postherpetic neural- visited our clinic with chronic chest pain around his left gia: irritable nociceptors and deafferentation. Neurobiol Dis. nipple. Over the past few decades, he had received medica- 1998;5(4):209–27. tions and neuroaxial interventions. Although he experienced 2. Kim YD, Park SJ, Shim J, Kim H. Clinical usefulness of pectoral spontaneous pain, the intensity and distribution of the pain nerve block for the management of zoster-associated pain: case reports and technical description. J Anesth. 2016;30(6):1074–7. This comment refers to the article available at: https ://doi. org/10.1007/s0054 0-016-2248-4. * Dae Seok Oh yivangin@naver.com Inje University Haeundae Paik Hospital, Busan, Republic of Korea Vol:.(1234567890) 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Anesthesia Springer Journals

Pecs II block for intractable postherpetic neuralgia

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Publisher
Springer Journals
Copyright
Copyright © 2018 by Japanese Society of Anesthesiologists
Subject
Medicine & Public Health; Anesthesiology; Pain Medicine; Intensive / Critical Care Medicine; Emergency Medicine
ISSN
0913-8668
eISSN
1438-8359
D.O.I.
10.1007/s00540-018-2496-6
Publisher site
See Article on Publisher Site

Abstract

Journal of Anesthesia (2018) 32:460 https://doi.org/10.1007/s00540-018-2496-6 LE T TER TO  THE   EDITOR Dae Seok Oh Received: 2 February 2018 / Accepted: 12 April 2018 / Published online: 25 April 2018 © Japanese Society of Anesthesiologists 2018 To the Editor: had diminished gradually, and the localized allodynia with a numeric rating scale of 7/10 around the nipple remained. The peripheral and central pathophysiological mechanisms We performed US-guided Pecs II block with 20 ml of 0.2% contribute to postherpetic neuralgia (PHN). A peripheral ropivacaine. His pain relief scale was at a 70–80% reduction nerve block may be used as an alternative option with which after the procedure. This symptom relief was maintained to treat localized peripheral neuralgia, as irritable periph- continuously following repeated blocks which were con- eral nociceptors are responsible for the spontaneous pain ducted at 3–4 days intervals. We suggest that the US-guided and allodynia [1]. We read with interest the article by Kim Pecs II block can be considered as an alternative option, not YD et al. suggested the clinical usefulness of US-guided only for cases in which neuroaxial blocks were contraindi- Pecs II blocks with which to treat PHN in patients for cated, but also, for an localized anterior chest wall pain asso- whom a neuroaxial block was contraindicated due to tak- ciated with PHN that was refractory to neuroaxial blocks. ing anticoagulants [2]. In addition, we report a patient with a localized intractable thoracic PHN who did not respond to various treatments, but in whom the US-guided Pecs II References block induced symptoms improvement. An 82-year-old man 1. Fields HL, Rowbotham M, Baron R. Postherpetic neural- visited our clinic with chronic chest pain around his left gia: irritable nociceptors and deafferentation. Neurobiol Dis. nipple. Over the past few decades, he had received medica- 1998;5(4):209–27. tions and neuroaxial interventions. Although he experienced 2. Kim YD, Park SJ, Shim J, Kim H. Clinical usefulness of pectoral spontaneous pain, the intensity and distribution of the pain nerve block for the management of zoster-associated pain: case reports and technical description. J Anesth. 2016;30(6):1074–7. This comment refers to the article available at: https ://doi. org/10.1007/s0054 0-016-2248-4. * Dae Seok Oh yivangin@naver.com Inje University Haeundae Paik Hospital, Busan, Republic of Korea Vol:.(1234567890) 1 3

Journal

Journal of AnesthesiaSpringer Journals

Published: Apr 25, 2018

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