Effect of 2% lidocaine continuous epidural infusion for thoracic or lumbar herpes-zoster-related pain

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Abstract

Few treatments are effective to manage herpes-zoster (HZ)-related pain. This retrospective study focused on the efficacy of 2% lidocaine continuous epidural infusion on pain control and quality of life in patients with thoracic or lumbar HZ.

A total of 256 patients with thoracic or lumbar HZ were reviewed for this study. Patients included in the study were divided into continuous epidural infusion (70 mL 2% lidocaine + 180 mL 0.9% normal saline) and medical therapy group (group1) and only medical therapy group (group2). European Organization for Research and Treatment of Cancer and Izbicki pain score were used to evaluate the pain control and quality of life before therapy, and 6 and 9 months after therapy.

For 256 patients with HZ (thoracic HZ = 162, lumbar HZ = 94), 53.1% was women. Mean ± standard deviation age was 69.4 ± 9.5 ( range, 38–85) years. Significant differences between the 2 groups in terms of quality of life and pain control were detected after 6 and 9 months follow-up (P < .001). For patients with HZ at 1 to 3 months after rash onset, the pain score was significantly lower in group 1 (P < .001). Sixteen patients with postherpetic neuralgia (PHN) underwent continuous epidural infusion therapy. Only 4 patients achieved satisfactory pain relief. Seven patients required analgesic drugs, and 6 patients still were unable to work, 10/16 (62.5%) patients had readmission. In addition, the pain score was higher in patients with HZ with diabetes (P < .001). Epidural infection occurred in 6 patients (8.8%), catheter dislodgement in 4 patients (5.8%), and catheter leakage in 3 patients (4.4%). There was no spinal epidural abscesses occurred.

2% lidocaine continuous epidural infusion therapy can lead to sustained pain relief and improve the quality of life in patients with for thoracic or lumbar HZ at 1 to 3 months after rash onset. Epidural lidocaine is avoided for the treatment PHN, and the level of glucose might be associated with zoster-related pain.

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