Erector Spinae Block Versus Thoracic Paravertebral Block for Acute Thoracic Herpes Zoster

Study Overview
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Brief Summary
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The aim of this research is to study and compare the efficacy and safety of single injection erector spinae plane block and thoracic paravertebral block in prevention of post herpetic neuralgia in patients with acute thoracic herpes zoster.

Official Title
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Ultrasound Guided Erector Spinae Block Versus Ultrasound Guided Thoracic Paravertebral Block for Pain Relief in Patients With Acute Thoracic Herpes Zoster

Conditions
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Acute Thoracic Herpes Zoster, Erector Spinae Plane Block, Thoracic Paravertebral Block, Pain Relief

Intervention / Treatment
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* Drug: Control Rx
* Procedure: Erector Spinae Block
* Procedure: Thoracic Paravertebral Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over 50 years of age Chest wall herpetic eruption of less than one week Moderate or severe pain Exclusion Criteria: Patient refusal Eruption more than one week duration Patients who will not receive appropriate anti-viral therapy Patients with mild pain Infection at the site of injection Patients with a history of renal, hepatic diseases, coagulopathy, steroid therapy, malignancies. Patient taking chemotherapy and/or radiotherapy.

Ages Eligible for Study
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Minimum Age: 51 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control Group<br>Patients of this group will receive standard treatment for herpes zoster which include acyclovir 800 mg, 5 times daily administered orally within the first 72 hours and analgesics as needed. | Drug: Control Rx<br>* Patients of this group will receive standard treatment for herpes zoster which include acyclovir 800 mg, 5 times daily administered orally within the first 72 hours and analgesics as needed<br>|
| Experimental: Erector Spinae Block (ESB) group<br>Patients of this group will receive 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone in a total volume of 10 ml (The final Patients of this group will receive 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone in a total volume of 10 ml(The final concentration of bupivacaine will be 0.25%) to be injected beneath the erector spinae muscle sheath) at the desired level under ultrasonography. The concentration of bupivacaine will be 0.25%) to be injected beneath the erector spinae muscle sheath) at the desired level under ultrasonography. | Procedure: Erector Spinae Block<br>* Patients of this group will receive 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone in a total volume of 10 ml (The final concentration of bupivacaine will be 0.25%) to be injected beneath the erector spinae muscle sheath) at the desired level under ultrasonography.<br>|
| Experimental: Thoracic Paravertebral Block group<br>Patients will receive 25 mg bupivacaine 0.5%, plus 8mg dexamethasone in a total volume of 10 ml(The final concentration of bupivacaine will be 0.25%) to be injected in the Paravertebral space at the desired level under ultrasonography | Procedure: Thoracic Paravertebral Block<br>* Patients of this group will receive 25 mg bupivacaine 0.5% , plus 8mg dexamethasone in a total volume of 10 ml(The final concentration of bupivacaine will be 0.25%) to be injected in the Paravertebral space at desired level under ultrasonography<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of post herpetic neuralgia (PHN) | Persistent herpetic pain after 3 months will reported as post herpetic neuralgia (PHN) | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog Scale | Visual Analog Scale (VAS) at baseline, 3, 4, 12, 24 weeks | 6 months | 
| Total consumption of rescue analgesia | Rescue analgesia in the form of Acetaminophen in a dose of 1,000 mg will be given if Visual Analog Scale (VAS) ≥4 | 6 months | 
| The times of complete resolution of pain | The times of complete resolution of pain (from the date of block until complete disappearance of herpetic pain) | 3 months | 
| Adverse effects and complications | Hypotension Pneumothorax Local anesthetic toxicity Respiratory depression | 1 day |