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| 22KS-019 |
S2 neuroplasty for sacral postherpetic neuralgia
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Introduction: Sacral dermatomal involvement occurs in only 3% of patients with postherpetic neuralgia (PHN) [1]. Although rare, these patients can suffer from severely agnozing and disabling pain. [2]
Case: An 88-year-old female patient visited our clinic with severe intermittent pain in her perineum. It had lasted for 10 months after the onset of herpes zoster in genital and anal area. The pain was stinging and squeezing with numeric rating scale (NRS) of 7 in pain intensity. Though the patient regularly took gabapetin and used lidocaine spray, the pain was not controlled at all. She hadn’t ever received interventional treatment before. In our pain clinic, we performed several interventional treatements repeatedly such as ganglion impar blocks, caudal epidural steroid injections, and sono-guided bilateral pudendal nerve blocks. Neverthelss, these were ineffective or effective only for short term period less than 2 weeks. The patient wanted to undergo other further procedures. Therefore, sacral nerve 2 (S2) neuroplasty was performed using EDEN catheter. After the catheter tip was placed in right second sacral foramen under fluoroscopic guidance, 3cc of 1% lidocaine and subsequent 3cc of 5% hypertonic saline were administered via indwelling catheter. The same injectates were administered repeatedly three more times with 1 hour intervals. After the procedure, the pain was significantly reduced, but remained with NRS 3 in intensity. We performed another S2 neuroplasty (2 months after the initial procedure), then the pain was nearly completely relieved for 1 month. As the pain gradually increased again over three months since the second procedure, we repeated it one more time (4 months after the second procedure). After then, the pain decreased to NRS 2 and the effect lasted for 8 months.
Conclusion: S2 neuroplasty may be helpful in sacral PHN.
References
[1] Peter C, Watson N, Loeser JD: Herpes zoster and postherpetic neurolgia, Bonica’s Management of Pain, 3rd edition.
[2] Sacral Postherpetic Neuralgia and Successful Treatment Using a Paramedial Approach to the Ganglion Impar
Russell K. McAllister, M.D.; Brad W. Carpentier, M.D.; Gerald Malkuch, M.D.
Anesthesiology December 2004, Vol. 101, 1472
Case: An 88-year-old female patient visited our clinic with severe intermittent pain in her perineum. It had lasted for 10 months after the onset of herpes zoster in genital and anal area. The pain was stinging and squeezing with numeric rating scale (NRS) of 7 in pain intensity. Though the patient regularly took gabapetin and used lidocaine spray, the pain was not controlled at all. She hadn’t ever received interventional treatment before. In our pain clinic, we performed several interventional treatements repeatedly such as ganglion impar blocks, caudal epidural steroid injections, and sono-guided bilateral pudendal nerve blocks. Neverthelss, these were ineffective or effective only for short term period less than 2 weeks. The patient wanted to undergo other further procedures. Therefore, sacral nerve 2 (S2) neuroplasty was performed using EDEN catheter. After the catheter tip was placed in right second sacral foramen under fluoroscopic guidance, 3cc of 1% lidocaine and subsequent 3cc of 5% hypertonic saline were administered via indwelling catheter. The same injectates were administered repeatedly three more times with 1 hour intervals. After the procedure, the pain was significantly reduced, but remained with NRS 3 in intensity. We performed another S2 neuroplasty (2 months after the initial procedure), then the pain was nearly completely relieved for 1 month. As the pain gradually increased again over three months since the second procedure, we repeated it one more time (4 months after the second procedure). After then, the pain decreased to NRS 2 and the effect lasted for 8 months.
Conclusion: S2 neuroplasty may be helpful in sacral PHN.
References
[1] Peter C, Watson N, Loeser JD: Herpes zoster and postherpetic neurolgia, Bonica’s Management of Pain, 3rd edition.
[2] Sacral Postherpetic Neuralgia and Successful Treatment Using a Paramedial Approach to the Ganglion Impar
Russell K. McAllister, M.D.; Brad W. Carpentier, M.D.; Gerald Malkuch, M.D.
Anesthesiology December 2004, Vol. 101, 1472
