• Sameh Abdelhalik Ahmed, Amr Ahmed Magdy, Mohammad Ali Abdullah, and Amr Arafa Albadry.
• Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Egypt.
• Pain Physician. 2022 Aug 1; 25 (5): 365-372.

BackgroundThe best tool for management of postherpetic neuralgia (PHN) is a matter of debate. The use of ultrasound-guided erector spinae plane block (ESPB) in patients with PHN may decrease pain severity and the need for analgesics.ObjectivesThe objective of this clinical study was to test the efficacy of ESPB with and without the addition of magnesium sulphate on pain control and analgesic consumption in patients with PHN.Study DesignRandomized controlled double-blinded trial.SettingA single university center.MethodsA total of 75 patients with PHN were included in the study. Patients were randomly divided into 3 equal groups. Group A received sham ESPB (2 mL normal saline), Group B received ESPB with 20 mL of bupivacaine (0.25%), and Group C received ESPB with 20 mL of bupivacaine (0.25%) and 100 mg magnesium sulphate. All patients received standard medical care. The pain score, the consumption of pregabalin and acetaminophen, the incidence of complications, and the patient's satisfaction were measured and recorded.ResultsIn comparison to the control group, the use of real ESPB with or without the addition of magnesium significantly decreased the Numeric Rating Scale score for pain during the first week of follow-up (P < 0.05); decreased the mean daily consumption of pregabalin and acetaminophen from the third to the twelfth week of follow-up (P < 0.05); and increased the level of patients' satisfaction (P = 0.03). The addition of magnesium sulphate showed an insignificant difference in comparison to the use of bupivacaine alone in ESPB (P ? 0.05).LimitationsThe study was limited by being a singlecenter study, using a single-level injection, and using a single volume of local anesthetic mixture.ConclusionESPB with or without adding magnesium sulphate is an effective pain management tool for cases of PHN. It leads to a significant decrease in pain score and analgesic requirements.

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