Ultrasound-Guided Thoracic Paravertebral Block With Steroid and Local Anesthetic for Acute Herpes Zoster: Effects on Pain Control and Prevention of Postherpetic Neuralgia

Ultrasound-Guided Thoracic Paravertebral Block With Steroid and Local Anesthetic for Acute Herpes Zoster: Effects on Pain Control and Prevention of Postherpetic Neuralgia: A Randomized Controlled Trial

Background: Acute herpes zoster causes severe neuropathic pain and may progress to postherpetic neuralgia (PHN). This study aims to evaluate ultrasound-guided thoracic paravertebral block with local anesthetic and steroid in reducing acute pain and PHN incidence.

Methods: This prospective randomized study included 100 patients diagnosed with acute thoracic herpes zoster (rash ≤14 days, NRS ≥4). Participants were allocated into two groups: a control group receiving standard medical treatment and an intervention group receiving standard treatment in addition to an ultrasound-guided thoracic paravertebral block with (0.25% bupivacaine + 40 mg methylprednisolone) at 48-72-hour intervals. Pain intensity was assessed at baseline and during follow-up. The incidence of postherpetic neuralgia was recorded. Secondary outcomes included analgesic consumption and patient satisfaction.

Study Overview

• Status: Completed
• Conditions: Postherpetic Neuralgia
• Intervention / Treatment: Drug: Valacyclovir + Paracetamol (Acetaminophen) + Gabapentin (standard medical therapy); Procedure: Ultrasound-guided thoracic paravertebral block (TPVB) with bupivacaine 0.25% + methylprednisolone 40 mg

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Phase 3

Contacts and Locations

Study Locations

• Egypt
  • Asyut, Egypt, 1987
    • Marwa Mahmoud Rady

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Eligibility Criteria Inclusion Criteria

Age 45-65 years

Diagnosed with acute thoracic herpes zoster

Rash duration ≤ 14 days

Moderate to severe pain, defined as NRS ≥ 4

Total sample size: 100 patients

Exclusion Criteria

Contraindications to thoracic paravertebral block, including:

Coagulopathy

Infection at the injection site

Allergy to local anesthetics or steroids

Immunosuppression or ongoing chemotherapy

Pre-existing chronic pain in the same affected region

Severe cognitive impairment or psychiatric illness preventing reliable pain assessment

Pregnancy or lactation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Standard medical therapy for acute thoracic herpes zoster; Participants received standard medical therapy consisting of: Valacyclovir 1000 mg orally three times daily for 7 days Paracetamol (Acetaminophen) 1 g orally twice daily for 14 days Gabapentin starting at 300 mg/day, titrated according to pain intensity and tolerance, up to a maximum of 1800 mg/day	Drug: Valacyclovir + Paracetamol (Acetaminophen) + Gabapentin (standard medical therapy); Participants received standard medical therapy consisting of: Valacyclovir 1000 mg orally three times daily for 7 days Paracetamol (Acetaminophen) 1 g orally twice daily for 14 days Gabapentin starting at 300 mg/day, titrated according to pain intensity and tolerance, up to a maximum of 1800 mg/day
Active Comparator: Ultrasound-guided thoracic paravertebral block (TPVB) with local anesthetic + corticosteroid; Participants received an ultrasound-guided thoracic paravertebral block (TPVB) using an injectate volume of 15 mL, consisting of: Bupivacaine 0.25% (local anesthetic) Methylprednisolone 40 mg (corticosteroid) The block was performed at the thoracic level corresponding to maximal pain/dermatomal involvement, and was repeated every 48 hours for a total of three sessions.	Drug: Valacyclovir + Paracetamol (Acetaminophen) + Gabapentin (standard medical therapy); Participants received standard medical therapy consisting of: Valacyclovir 1000 mg orally three times daily for 7 days Paracetamol (Acetaminophen) 1 g orally twice daily for 14 days Gabapentin starting at 300 mg/day, titrated according to pain intensity and tolerance, up to a maximum of 1800 mg/day; Procedure: Ultrasound-guided thoracic paravertebral block (TPVB) with bupivacaine 0.25% + methylprednisolone 40 mg; Participants received an ultrasound-guided thoracic paravertebral block (TPVB) using an injectate volume of 15 mL, consisting of: Bupivacaine 0.25% (local anesthetic) Methylprednisolone 40 mg (corticosteroid) The block was performed at the thoracic level corresponding to maximal pain/dermatomal involvement, and was repeated every 48 hours for a total of three sessions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The primary outcome was the incidence of postherpetic neuralgia (PHN), defined as a Numerical Rating Scale (NRS) pain score ≥4 persisting 90 days after rash onset.	The primary outcome was the incidence of postherpetic neuralgia (PHN), defined as a Numerical Rating Scale (NRS) pain score ≥4 persisting 90 days after rash onset.	till 3 month

Collaborators and Investigators

• Sponsor: Assiut University

Study record dates

Study Major Dates

• Study Start (Actual): March 15, 2023
• Primary Completion (Actual): September 20, 2025
• Study Completion (Actual): October 10, 2025

Study Registration Dates

• First Submitted: January 14, 2026
• First Submitted That Met QC Criteria: January 15, 2026
• First Posted (Actual): January 20, 2026

Study Record Updates

• Last Update Posted (Actual): January 20, 2026
• Last Update Submitted That Met QC Criteria: January 15, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Nervous System Diseases; Neuromuscular Diseases; Peripheral Nervous System Diseases; Neuralgia; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Neuralgia, Postherpetic; Amino Acids, Peptides, and Proteins; Organic Chemicals; Heterocyclic Compounds; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Hydrocarbons; Cyclohexanes; Cycloparaffins; Hydrocarbons, Alicyclic; Hydrocarbons, Cyclic; Acids, Acyclic; Carboxylic Acids; Polycyclic Compounds; Anilides; Amides; Aniline Compounds; Amines; Acetanilides; Guanine; Hypoxanthines; Purinones; Purines; Amino Acids; Pregnadienes; Pregnanes; Steroids; Fused-Ring Compounds; Pregnadienetriols; gamma-Aminobutyric Acid; Aminobutyrates; Butyrates; Acids, Carbocyclic; Cyclohexanecarboxylic Acids; Prednisolone; Acyclovir; Gabapentin; Valacyclovir; Acetaminophen; Methylprednisolone
• Other Study ID Numbers: 20260230004

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

IPD Plan Description

Plan Description

De-identified individual participant data (IPD) will not be shared outside the study team.

Access Criteria

Not applicable.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes