Comparative effectiveness of nerve block strategies for preventing postherpetic neuralgia in thoracic herpes zoster: a network meta-analysis
BackgroundShingles is a common global disease, with the chest region being one of its most frequently affected areas. Postherpetic neuralgia (PHN) is one of the most common and debilitating complications of this disease, characterized by high incidence, prolonged duration, and treatment resistance,...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1612871/full |
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| author | Wensheng Lu Shengze He Qi Liu Yaozu Gu Jie Bai |
| author_facet | Wensheng Lu Shengze He Qi Liu Yaozu Gu Jie Bai |
| author_sort | Wensheng Lu |
| collection | DOAJ |
| description | BackgroundShingles is a common global disease, with the chest region being one of its most frequently affected areas. Postherpetic neuralgia (PHN) is one of the most common and debilitating complications of this disease, characterized by high incidence, prolonged duration, and treatment resistance, severely affecting patients’ daily life and quality of life. Currently, research on the prevention of PHN remains limited. Nerve block, as a promising intervention, has been widely applied in clinical pain management. However, there is still no consensus on the efficacy and safety of different nerve block techniques for the prevention of chest-related PHN, warranting further systematic evaluation and comparison.MethodsA network meta-analysis was conducted using RevMan 5.4 and Stata 18.0, analyzing data from nine studies retrieved from four English-language databases: MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL).ResultThis study included a total of 9 randomized controlled trials, involving 741 patients with chest herpes zoster and 8 different interventions. The results of the network meta-analysis indicated that the top three interventions in terms of total effective rate were: PVB: Amide local anesthetics + Methylene blue > PVB: Methylene blue > ESPB: Amide local anesthetics + Glucocorticoid. In terms of pain level, as assessed by the Visual Analogue Scale, the top three interventions were: PVB: Amide local anesthetics + Glucocorticoid > PVB: Amide local anesthetics > ESPB: Amide local anesthetics + Glucocorticoid.ConclusionThe results of this study indicate that PVB is superior to ESPB in both reducing VAS scores and improving the total effective rate. Among the interventions, PVB: Amide local anesthetics + Methylene blue demonstrated the best performance in terms of total effective rate, while PVB: Amide local anesthetics + Glucocorticoid showed the most significant effect in reducing VAS scores.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024604329. |
| format | Article |
| id | doaj-art-cc624ef9ce2049e1a4b732a5622347d5 |
| institution | Kabale University |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj-art-cc624ef9ce2049e1a4b732a5622347d52025-08-20T03:46:50ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-08-011610.3389/fneur.2025.16128711612871Comparative effectiveness of nerve block strategies for preventing postherpetic neuralgia in thoracic herpes zoster: a network meta-analysisWensheng Lu0Shengze He1Qi Liu2Yaozu Gu3Jie Bai4Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, ChinaDepartment of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, ChinaDepartment of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, ChinaThe Second Clinical Medical School, Lanzhou University, Lanzhou, ChinaDepartment of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, ChinaBackgroundShingles is a common global disease, with the chest region being one of its most frequently affected areas. Postherpetic neuralgia (PHN) is one of the most common and debilitating complications of this disease, characterized by high incidence, prolonged duration, and treatment resistance, severely affecting patients’ daily life and quality of life. Currently, research on the prevention of PHN remains limited. Nerve block, as a promising intervention, has been widely applied in clinical pain management. However, there is still no consensus on the efficacy and safety of different nerve block techniques for the prevention of chest-related PHN, warranting further systematic evaluation and comparison.MethodsA network meta-analysis was conducted using RevMan 5.4 and Stata 18.0, analyzing data from nine studies retrieved from four English-language databases: MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL).ResultThis study included a total of 9 randomized controlled trials, involving 741 patients with chest herpes zoster and 8 different interventions. The results of the network meta-analysis indicated that the top three interventions in terms of total effective rate were: PVB: Amide local anesthetics + Methylene blue > PVB: Methylene blue > ESPB: Amide local anesthetics + Glucocorticoid. In terms of pain level, as assessed by the Visual Analogue Scale, the top three interventions were: PVB: Amide local anesthetics + Glucocorticoid > PVB: Amide local anesthetics > ESPB: Amide local anesthetics + Glucocorticoid.ConclusionThe results of this study indicate that PVB is superior to ESPB in both reducing VAS scores and improving the total effective rate. Among the interventions, PVB: Amide local anesthetics + Methylene blue demonstrated the best performance in terms of total effective rate, while PVB: Amide local anesthetics + Glucocorticoid showed the most significant effect in reducing VAS scores.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024604329.https://www.frontiersin.org/articles/10.3389/fneur.2025.1612871/fullherpes zosternerve blockacute zoster-related painpostherpetic neuralgiaerector spinae plane blockparavertebral block |
| spellingShingle | Wensheng Lu Shengze He Qi Liu Yaozu Gu Jie Bai Comparative effectiveness of nerve block strategies for preventing postherpetic neuralgia in thoracic herpes zoster: a network meta-analysis Frontiers in Neurology herpes zoster nerve block acute zoster-related pain postherpetic neuralgia erector spinae plane block paravertebral block |
| title | Comparative effectiveness of nerve block strategies for preventing postherpetic neuralgia in thoracic herpes zoster: a network meta-analysis |
| title_full | Comparative effectiveness of nerve block strategies for preventing postherpetic neuralgia in thoracic herpes zoster: a network meta-analysis |
| title_fullStr | Comparative effectiveness of nerve block strategies for preventing postherpetic neuralgia in thoracic herpes zoster: a network meta-analysis |
| title_full_unstemmed | Comparative effectiveness of nerve block strategies for preventing postherpetic neuralgia in thoracic herpes zoster: a network meta-analysis |
| title_short | Comparative effectiveness of nerve block strategies for preventing postherpetic neuralgia in thoracic herpes zoster: a network meta-analysis |
| title_sort | comparative effectiveness of nerve block strategies for preventing postherpetic neuralgia in thoracic herpes zoster a network meta analysis |
| topic | herpes zoster nerve block acute zoster-related pain postherpetic neuralgia erector spinae plane block paravertebral block |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1612871/full |
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