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REVIEW article

Front. Neurol.

Sec. Neurorehabilitation

Volume 16 - 2025 | doi: 10.3389/fneur.2025.1612871

Comparative Effectiveness of Nerve Block Strategies for Preventing Postherpetic Neuralgia in Thoracic Herpes Zoster: A Network Meta-Analysis

Provisionally accepted
Wensheng  LuWensheng Lu1Shengze  HeShengze He1Qi  LiuQi Liu1Yaozu  GuYaozu Gu2Jie  BaiJie Bai1*
  • 1Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
  • 2Lanzhou University, Lanzhou, Gansu Province, China

The final, formatted version of the article will be published soon.

Background: Shingles 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. Methods: A 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). Result: This 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. Conclusion: The 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.

Keywords: Herpes Zoster, Nerve Block, acute zoster-related pain, postherpetic neuralgia, Erector spinae plane block, Paravertebral block, Network meta-analysiy

Received: 16 Apr 2025; Accepted: 24 Jul 2025.

Copyright: © 2025 Lu, He, Liu, Gu and Bai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Jie Bai, Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, China

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