게시판
| 21KS-012 |
Safe drug treatment and procedure for herpes zoster in pregnancy
Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Introduction: A first infection of varicella-zoster virus (VZV) during pregnancy can cause serious systemic disease to both mother and the fetus. Despite this maternal herpes zoster (HZ) does not increase fetal mortality, and the transmission of varicella-zoster virus to the fetus rarely occurs. Although HZ infection has a minimal effect on the fetus, maternal HZ can cause significant complications for the mother.
Case report: A 34-year-old woman in week 22 of pregnancy came with flank pain and a rash (NRS 4). She noticed the lesions about 5 days earlier. On examination, an erythematous papulovesicular eruption was observed within the right T6-7 dermatome. Under the diagnosis of HZ, a right T6 paravertebral block(0.4% lidocaine 10mL) and right 5,6,7 inter-costal nerve blocks(0.4% lidocaine 5mL per level) were done. She was prescribed valtrex one gram and acetaminophen 300 mg PRN for breakthrough pain. 7 days after initial vesicle, she described that the pain intensity had been reduced to NRS 1-2. She had experienced breakthrough pain of NRS 4 once or twice, and then took acetaminophen. Nerve blocks were carried out in the same way, and then she was prescribed valtrex 1g tid for 7 days.
General treatment of HZ during pregnancy consisted of giving anti-viral drugs or taking acetaminophen for pain. Although studies on the safety of anti-viral drugs in pregnancy are scarce, several studies report there is little effect on the fetus. Anti-viral drugs are classified for pregnant women in category B, acyclovir, and valacyclovir are recommended for mothers. Acetaminophen is the only category B oral analgesic for pregnant women and can be safely used on the second trimester.
Conclusion: In this case, by performing nerve blocks, the intensity of the acute-phase pain was reduced and the rate of post-herpetic neuralgia was lowered. Steroids that can be commonly used in the acute phase were not used in category C, instead only local anesthetics were used. It is thought that future research on nerve blocks will require large-scale prospective clinical studies.
References:
1. Robyn S, Melissa D, Julia C. Herpes zoster in pregnancy. J Midwifery Womens Health 2019;64:230235.
2. Maryam S, ImanA. Severe herpes zoster neuralgia in a pregnant woman treated with acetaminophen. Acta Med Iran 2014;52:238
Case report: A 34-year-old woman in week 22 of pregnancy came with flank pain and a rash (NRS 4). She noticed the lesions about 5 days earlier. On examination, an erythematous papulovesicular eruption was observed within the right T6-7 dermatome. Under the diagnosis of HZ, a right T6 paravertebral block(0.4% lidocaine 10mL) and right 5,6,7 inter-costal nerve blocks(0.4% lidocaine 5mL per level) were done. She was prescribed valtrex one gram and acetaminophen 300 mg PRN for breakthrough pain. 7 days after initial vesicle, she described that the pain intensity had been reduced to NRS 1-2. She had experienced breakthrough pain of NRS 4 once or twice, and then took acetaminophen. Nerve blocks were carried out in the same way, and then she was prescribed valtrex 1g tid for 7 days.
General treatment of HZ during pregnancy consisted of giving anti-viral drugs or taking acetaminophen for pain. Although studies on the safety of anti-viral drugs in pregnancy are scarce, several studies report there is little effect on the fetus. Anti-viral drugs are classified for pregnant women in category B, acyclovir, and valacyclovir are recommended for mothers. Acetaminophen is the only category B oral analgesic for pregnant women and can be safely used on the second trimester.
Conclusion: In this case, by performing nerve blocks, the intensity of the acute-phase pain was reduced and the rate of post-herpetic neuralgia was lowered. Steroids that can be commonly used in the acute phase were not used in category C, instead only local anesthetics were used. It is thought that future research on nerve blocks will require large-scale prospective clinical studies.
References:
1. Robyn S, Melissa D, Julia C. Herpes zoster in pregnancy. J Midwifery Womens Health 2019;64:230235.
2. Maryam S, ImanA. Severe herpes zoster neuralgia in a pregnant woman treated with acetaminophen. Acta Med Iran 2014;52:238
