Efficacy of thoracic erector spinae block in enhancing short term outcome for patients with post herpetic neuralgia.

Background Postherpetic neuralgia (PHN) remains a major source of chronic neuropathic pain following herpes zoster infection, often resistant to conventional systemic analgesics. The condition severely affects patients’ quality of life, and current pharmacologic therapies may provide only partial relief or cause intolerable side effects. The erector spinae plane (ESP) block has recently emerged as a promising ultrasound-guided regional technique for managing neuropathic pain conditions, including PHN. Methods This prospective, randomized, double-blind, placebo-controlled clinical trial enrolled forty-four adult patients with established PHN. Participants were randomized equally to receive either an ultrasound-guided thoracic ESP block using 0.25% bupivacaine combined with 40 mg triamcinolone or a sham subcutaneous saline infiltration. Pain intensity was measured using the visual analog scale (VAS) at baseline, 1 day, 1 week, 1 month, and 3 months post-procedure. Analgesic consumption and adverse events were also recorded throughout follow-up. Results Compared with the control group, the ESP block group demonstrated significantly lower VAS scores across all follow-up points (p < 0.001) and required substantially less analgesic medication over time. The degree of pain reduction was most pronounced from the first postoperative day and persisted through the third month. No major complications were reported, confirming the procedure’s safety and tolerability. Conclusion Thoracic ESP block offers rapid, durable, and clinically significant pain relief for patients with postherpetic neuralgia. It is a safe, minimally invasive, and effective component of multimodal pain management strategies, reducing both pain intensity and analgesic requirements.