• Clin J Pain · Sep 2004

    Randomized Controlled Trial Comparative Study Clinical Trial

    Optimum pain relief with continuous epidural infusion of local anesthetics shortens the duration of zoster-associated pain.

    • Haruhiko Manabe, Kenjiro Dan, Kazuhiko Hirata, Koichiro Hori, Shinjiro Shono, Shinichiro Tateshi, Hiroyuki Ishino, and Kazuo Higa.
    • Department of Anesthesiology, Kitakyushu Municipal Medical Center, Bashaku, Kokurakita-ku, Japan. hymanabe@mx7.tiki.ne.jp
    • Clin J Pain. 2004 Sep 1; 20 (5): 302-8.

    ObjectiveTo 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.DesignA prospective, double-blind, randomized, placebo-controlled study.SettingA university hospital and an affiliated clinic in Japan from 1996 through 1999.Patients56 immunocompetent herpes zoster (HZ) patients, 50 years or older, within 10 days of rash onset and with severe pain and eruption.InterventionsPatients 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.Outcome MeasuresThe number of days required for complete cessation of ZAP and the proportion of subjects with allodynia beyond 30 days.ResultsThe 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).ConclusionsCEI 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.

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