Erector Spinae Plane Block Combined with Subcutaneous Dextrose Prolotherapy for Gabapentin-Refractory Thoracic Postherpetic Neuralgia: A Case Report

Abstract

Background : Postherpetic neuralgia (PHN) can lead to chronic pain that significantly impacts a patient's quality of life. This condition often proves resistant to standard analgesic treatments.

Case Illustration : A 50-year-old female patient who came with a severe (8/10), persistent, burning stabbing, tingling pain in the right breast area after she had gotten a dermatologist-well-treated acute herpes zoster infection 2 months prior. She had been prescribed with escalated doses of Gabapentin for over two weeks by her dermatovenereologist, but her pain still remained. Physical examination revealed a redness-black crust lesion located in several areas of the right chest, axilla, and upper right back, allodynia and hyperalgesia in the right T3-T5 dermatome. Afterwards, she was diagnosed with PHN. A combination erector spinae plane block (ESPB) and prolotherapy was performed to relieve the pain symptom. The patient experienced significant pain relief (8/10 to 2/10), 15 minutes after the procedure had been done, and patient was given paracetamol 500 mg every 8 hours and gabapentin 100 mg every 8 hours for 7 days as the follow-up management, and amitriptyline 12.5 mg per 24 hours at night in addition because of her increasing pain by day 3. By day 14, patient felt her pain had significantly reduced; therefore she felt that she did not need to visit pain clinic anymore.

Conclusion : The management of postherpetic neuralgia (PHN) requires a multimodal approach. Prolotherapy with subcutaneous dextrose injection into the lesions, combined with ESPB, may offer a treatment option for patients who do not respond to conventional therapies.