pISSN 2005-9159
eISSN 2093-0569

Review Article

Korean J Pain 2017; 30(1): 3-17

Published online January 31, 2017 https://doi.org/10.3344/kjp.2017.30.1.3

Copyright © The Korean Pain Society.

Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis

Hyun Jung Kim1,*, Hyeong Sik Ahn1,*, Jae Young Lee2, Seong Soo Choi2, Yu Seon Cheong3, Koo Kwon2, Syn Hae Yoon2, and Jeong Gill Leem2*

1Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea.

2Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

3Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea.

Correspondence to: Jeong Gill Leem. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3861, Fax: +82-2-470-1363, jgleem@amc.seoul.kr

Received: December 1, 2016; Revised: December 9, 2016; Accepted: December 24, 2016

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids.


This systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy.


Nine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events.


Applying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed.

Keywords: Epidural block, Herpes zoster, Nerve block, Paravertebral block, Postherpetic neuralgia, Stellate ganglion block