SUCCESSFUL MANAGEMENT OF SACRAL POSTHERPETIC NEURALGIA WITH GANGLION IMPAR BLOCK - A CASE REPORT
Keywords:Chronic pain, Sacral, Postherpetic neuralgia, Ganglion impar block
Postherpetic neuralgia (PHN) is one of the most common and important complications of severe varicella-zoster infection, especially occurring in 20% of the elderly patients. A 59-year-old female presented with pain in the right sacral region for the past 3 months. The pain was preceded by herpes zoster. She was diagnosed as a case of Sacral PHN. We administered paramedian approach of ganglion impar block with 10 ml of 0.25% bupivacaine with 8 mg dexamethasone which resulted in immediate adequate pain relief. On follow-up after 8 weeks, the pain score continued to be less with 3/10. No complications were encountered. There was no sensory loss. We conclude that ganglion impar block with a combination of local anesthetic and steroid is a viable treatment option for sacral PHN.
Gauthier A, Breuer J, Carrington D, Martin M, Rémy V. Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect 2009;137:38-47.
Dworkin RH, Schmader KE. Treatment and prevention of postherpetic neuralgia. Clin Infect Dis 2003;36:877-82.
Weller TH. Varicella and herpes zoster: A perspective and overview. J Infect Dis 1992;166 Suppl 1:S1-6.
Cunningham AL, Dworkin RH. The management of post-herpetic neuralgia. BMJ 2000;321:778-9.
Waldman SD, editor. Hypogastric plexus block and impar ganglion block. In: Pain Management. Philadelphia, PA: Saunders/Elsevier; 2007. p. 1354-7.
Bowsher D. Post-herpetic neuralgia in older patients. Incidence and optimal treatment. Drugs Aging 1994;5:411-8.
Winnie AP, Hartwell PW. Relationship between time of treatment of acute herpes zoster with sympathetic blockade and prevention of post-herpetic neuralgia: Clinical support for a new theory of the mechanism by which sympathetic blockade provides therapeutic benefit. Reg Anesth 1993;18:277-82.
Raj PP, Lou L, Erdine S, Staats PS. Ganglion of impar block. In: Raj PP, editor. Radiographic Imaging for Regional Anesthesia and Pain Management. New York: Churchill Livingstone; 2003. p. 238-41.
Plancarte R, Amescua C, Patt RB, Allende S. Presacral blockade of the ganglion of Walter (ganglion impar). Anesthesiology 1990;73:A751.
Wemm K Jr., Saberski L. Modified approach to block the ganglion impar (ganglion of walther). Reg Anesth 1995;20:544-5.
Huang JJ. Another modified approach to the ganglion of walther block (ganglion of impar). J Clin Anesth 2003;15:282-3.
Pasqualucci A, Pasqualucci V, Galla F, De Angelis V, Marzocchi V, Colussi R, et al. Prevention of post-herpetic neuralgia: Acyclovir and prednisolone versus epidural local anesthetic and methylprednisolone. Acta Anaesthesiol Scand 2000;44:910-8.
McAllister RK, Carpentier BW, Malkuch G. Sacral postherpetic neuralgia and successful treatment using a paramedial approach to the ganglion impar. Anesthesiology 2004;101:1472-4.
Nasare N, Banerjee B, Deshmukh P, Mediratta P, Ahmed R, Saxena A, et al. The impact of pharmacogenetics on adverse drug reactions to predict the efficacy of tramadol monotherapy for the treatment of post herpetic neuralgia patients. Int J Pharm Pharm Sci 2014;6:89-96.
Nasare N, Mediratta P, Banerjee B, Deshmukh P, Saxena A, Bhattacharya S, et al. Assessment of cyp2d6*10 polymorphism with post herpetic neuralgia patients undergoing tramadol treatment. Int J Pharm Pharm Sci 2014;6:97-102.
Lin CS, Cheng JK, Hsu YW, Chen CC, Lao HC, Huang CJ, et al. Ultrasound-guided ganglion impar block: A technical report. Pain Med 2010;11:390-4.
How to Cite
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.