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pISSN 2005-9159
eISSN 2093-0569

Clinical Research Article

Korean J Pain 2021; 34(4): 509-533

Published online October 1, 2021 https://doi.org/10.3344/kjp.2021.34.4.509

Copyright © The Korean Pain Society.

Pharmacological and non-pharmacological strategies for preventing postherpetic neuralgia: a systematic review and network meta-analysis

Junhyeok Kim1 , Min Kyoung Kim1 , Geun Joo Choi1 , Hwa Yong Shin1 , Beom Gyu Kim2 , Hyun Kang1

1Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
2Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea

Correspondence to:Hyun Kang
Department ofAnesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjakgu, Seoul 06911, Korea
Tel: +82-2-6299-2571, 2579, or 2586
Fax: +82-2-6299-2585
E-mail: roman00@naver.com

*These authors contributed equally to this work and are co-first authors.

Handling Editor: Francis S. Nahm

Received: July 26, 2021; Revised: August 25, 2021; Accepted: August 29, 2021

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.

Background: Postherpetic neuralgia (PHN) is a refractory complication of herpes zoster (HZ). To prevent PHN, various strategies have been aggressively adopted. However, the efficacy of these strategies remains controversial. Therefore, we aimed to estimate the relative efficacy of various strategies used in clinical practice for preventing PHN using a network meta-analysis (NMA).
Methods: We performed a systematic and comprehensive search to identify all randomized controlled trials. The primary outcome was the incidence of PHN at 3 months after acute HZ. We performed both frequentist and Bayesian NMA and used the surface under the cumulative ranking curve (SUCRA) values to rank the interventions evaluated.
Results: In total, 39 studies were included in the systematic review and NMA. According to the SUCRA value, the incidence of PHN was lower in the order of continuous epidural block with local anesthetics and steroids (EPI-LSE), antiviral agents with subcutaneous injection of local anesthetics and steroids (AV + sLS), antiviral agents with intracutaenous injection of local anesthetics and steroids (AV + iLS) at 3 months after acute HZ. EPI-LSE, AV + sLS and AV + iLS were also effective in preventing PHN at 1 month after acute HZ. And paravertebral block combined with antiviral and antiepileptic agents was effective in preventing PHN at 1, 3, and 6 months.
Conclusions: The continuous epidural block with local anesthetics and steroid, antiviral agents with intracutaneous or subcutaneous injection of local anesthetics and a steroid, and paravertebral block combined with antiviral and antiepileptic agents are effective in preventing PHN.

Keywords: Anesthesia, Local, Anticonvulsants, Autonomic Nerve Block, Bayes Theorem, Injections, Epidural, Nerve Block, Network Meta-Analysis, Neuralgia, Postherpetic, Stellate Ganglion, Steroids, Systematic Review, Therapeutics.