Facial anesthetic blocks in the treatment of acute pain during ophthalmic zoster

BACKGROUND: Ophthalmic zoster is frequently accompanied by severe pain in the frontal and nasal divisions of the ophthalmic nerve. Treating this pain is often difficult, particularly in elderly patients, owing to iatrogenic effects and to interactions with the pre-existing diseases and treatments frequently present in this age group. The aim of our study was to consider the efficacy and toxicity of the frontal and nasal nerve blocks in the treatment of severe pain during acute ophthalmic zoster in the elderly. MATERIAL AND METHODS: A prospective study was conducted on 20 patients (mean age, 76 +/-7 years; range, 63-88) presenting with acute ophthalmic zoster with severe pain (less than 1 month since onset), which had resisted analgesic medication. All patients had a visual analogue score for pain (VAS) of 4 or more and received one or more anesthetic blocks of a compound of bupivacaine with adrenaline associated with clonidine at the frontal branch and sometimes the nasal branch levels of the ophthalmic nerve. Pain was measured daily by VAS for 5 days, and the blocks were repeated if the VAS was still 4 or higher. Patients were checked for local or systemic side effects. RESULTS: The number of anesthetic blocks per patient ranged from one to four (mean: 2.3 +/-0.7). All patients experienced less pain after the first injection. The mean preinjection VAS was 7.4 +/-1 and fell to 4.8 +/-1.0, 4.1 +/-1.1, 3.5 +/-1.0, 3.2 +/-0.6 and 2.8 +/-0.9 at day 1, day 2, day 3, day 4 and day 5, respectively (p<0.001). It was possible to reduce analgesic medication permanently in all patients. No local or systemic side effect was observed. CONCLUSION: Anesthetic blocks of the frontal and nasal branches, repeated if necessary, give fast and effective relief from the severe pain of acute ophthalmic zoster. They are fully tolerated and simple to administer, making them an excellent indication in the complementary treatment of the pain of hyperalgic acute zoster in the elderly.