Interscalen Block Application in Patients with Herpes Zoster

Abstract

Reactivation of the latent virus at the dorsal nerve roots and ganglia in patients with chickenpox history may result in quite painful, itchy, and blistering rash on a limited area of the sensory nerve and this condition is called Herpes Zoster or Zona. Herpes Zoster may resolve spontaneously in one or two weeks or course of disease may also be serious in elderly and immunocompromised individuals. Although providing an effective treatment is not always possible, sympathetic nerve block, antiviral agents, analgesics, and opioid drugs might be used. We believe that, sympathetic nerve blocks, with their inhibitory effects on the formation of the post-herpetic neuralgia, are one of the effective treatment modalities especially in patients with insufficient improvement after medications. In this case report, we aimed to present the use of interscalene brachial plexus nerve block to treat a patient with Herpes Zoster in the shoulder area. Key Words: Herpes Zoster; Bupivacaine; Brachial Plexus. Herpes Zosterli Hastada İnterskalen Blok UygulanmasıÖzet Daha önceden suçiçeği geçirmiş kişilerde arka sinir köklerinde ve ganglionlarda latent haldeki virüsün reaktivasyonu sonucu, ilgili sinirin duyusal alanıyla sınırlı, oldukça ağrılı ve kaşıntılı, vezikülo-büllöz döküntülü lezyonlarla karakterize tabloya Herpes Zoster veya Zona denilir. Herpes Zoster bir veya iki haftada kendiliğinden düzelebileceği gibi, özellikle yaşlılarda ve immün sistemi baskılanmış kişilerde ciddi seyredebilir. Herpes Zoster tedavisi kolay olmayıp her zaman etkin şekilde sağlanamamakla beraber, sempatik sinir bloğu, antiviral, analjezik ve opioid gibi ilaçlar kullanılabilmektedir. Özellikle ilaç tedavisinden yeterince fayda görmeyen hastalarda, meydana gelebilecek Postherpetik Nevralji oluşumunu önleyici etkileri de göz önüne alındığında sempatik sinir bloğu uygulaması etkin bir tedavi yöntemi olarak kullanılabileceği kanısındayız. Bu olgu sunusunda, omuz bölgesinde Herpes Zoster tutulumu olan hastanın interskalen blok ile tedavisini sunmayı amaçladık. Anahtar Kelimeler: Herpes Zoster; Bupivakain; Brakiyal Pleksus.Herpes Zoster (HZ) or shingles is the clinical picture in which the latent virus in the dorsal root ganglia is reactivated in people infected with Varicella-Zoster (VZ) chickenpox, especially in adults (1). HZ is characterised by quite painful vesiculobullous rash lesions limited to the right or left of the body and its incidence in the population is between 2,2% and 3,4% (2). The risk of HZ is 10-25% among adults with 95% VZ seropositivity and 50% of these patients are above 85 years of age (3).The following conditions which weaken the immune system, especially in elderly, increase the risk of HZ: organ transplantation, human immunodeficiency virus infection, malignant disease history, diabetes, chemotherapy and radiation therapy and chronic use of corticosteroids (3, 4).While antiviral, non-steroidal anti-inflammatory (NSAID), and opioid medications can be used in acute HZ treatment, sympathetic nerve block applications in the area ...