UPmémoires

English

Purpose: Evaluate the effectiveness of computed tomography (CT) guided epidural injection of steroids and local anesthetics for acute herpes zoster (HZ) pain and post-herpetic neuralgia.

Materials ans methods: A monocentric study was conducted from April 2017 to February 2019 including patients with HZ algia at any stage (acute or chronic defined as pain lasting more than 3 months). All patients were prospectively included after giving written informed consent. The study was conducted according to the International Ethical Guidelines and Declaration of Helsinki. The sensory ganglion of the affected dermatome and/or the affected sensory nerve was targeted under CT guidance and local injection of a mixture of two vials of Methylprednisolone 40 mg/1ml and 2 mL of Lidocaine 1% was injected. Using a visual analogue scale (VAS) ranging from 0 to 10, pain was assessed prior to procedure, and at day 7, 1 month, 3 months and 6 months. Adverse effects were graded according to the Interventional Radiology (SIR) classification.

Results: Twenty patients were included (14 acute zoster, 6 chronic). Mean VAS at baseline was 8.2±1.2 with significant decreases (p<0.0001) at day 7 (3.4±3.2), day 30 (3.4±3.2), day 90 (3.0±3.2), and day 180 (2.6±3.2). Infiltrations were significantly more efficient on acute zona then on chronic pain (p<0.001), and required significantly fewer infiltrations to relieve the pain (p=0.002). Only one grade A adverse event was registered.

Conclusion: Epidural injection of steroids and local anesthetics in herpes zoster is feasible, safe and seems to reduce pains with a stable effect over 6 months.

Keywords : Herpes Zoster, Post Herpetic Neuralgia, Infiltration, CT guided interventional procedures.