A prospective randomized comparison of the efficacy of standard antiviral therapy versus ultrasound-guided thoracic paravertebral block for acute herpes zoster

Figures & data

Figure 1. CONSORT diagram indicates the flow of recruited patients in this trial.

Figure 2. Paravertebral space puncture under ultrasound guidance.

Table 1. Baseline characteristics of participants in two groups.

Variables	Control group (N = 50)	TPVB group (N = 50)	p
Age (years)	63.93 ± 10.72	60.51 ± 10.69	.921
Female sex, n (%)	28 (45.2%)	26 (51.0%)	.776
Prodromal duration (days)	3.98 ± 1.80	4.35 ± 1.53	.157
ZBPI: baseline average pain score	7.44 ± 1.78	7.47 ± 1.78	.915
Distribution of pain, n (%)			.835
Single thoracic dermatomal	37 (59.7%)	31 (60.8%)
2–3 thoracic dermatomal	21 (33.9%)	18 (35.3%)
≥4 thoracic dermatomal	4 (6.5%)	2 (3.9%)
Affected side, n (%)			.577
Left	30 (48.4%)	22 (43.1%)
Right	32 (51.6%)	29 (56.9%)
Rash severity, n (%)			.934
Number of lesions < 50	47 (75.8%)	39 (76.5%)
Number of lesions ≥ 50	15 (24.2%)	12 (23.5%)
Haemorrhagic lesion, n (%)	8 (12.9%)	5 (9.8%)	.607
Concomitant disease, n (%)			.743
Hypertension	25 (40.3%)	21 (41.2%)
Diabetes mellitus	28 (45.2%)	25 (49.0%)
History of previous analgesic use, n (%)			.708
NSAID	38 (61.3%)	33 (64.7%)
Anti-epileptic or week opioid	24 (38.7%)	18 (35.3%)

ZBPI: Zoster Brief Pain Inventory; group A: antiviral therapy; group B: antiviral therapy plus US-guided TPVB by transverse short axial approach; NSAID: non-steroidal anti-inflammatory drugs.

Figure 3. Alteration in the consumption of rescue analgesics (celecoxib) in patients with inadequate pain relief in two groups during the follow-up period.

Table 2. HZ-BOI scores of two groups during study days 0–30, 30–90 and 90–180 according to PP analysis.

Group	BOI-30AUC				BOI-30–90AUC				BOI-90–180AUC
	Mean	95%CI	F	p	Mean	95%CI	F	p	Mean	95%CI	F	p
Control group (N = 41)	112.5	105.2, 119.9	32.252	<.001	102.3	85.2, 119.4	11.392	.001	91.1	72.3, 109.9	7.467	.007
TPVB group (N = 45)	82.7	75.4, 90.1			60.9	43.9, 78.1			54.3	35.6, 73.1

PP: per protocol; HZ: herpes zoster; BOI: burden of illness; AUC: area under the curve; CI: confidence interval.

Table 3. PHN incidence for control group versus TPVB group according to the PP analysis.

Outcome	Control group	TPVB group	Difference in incidence (95%CI)	Rate ratio (95%CI)	χ^2 value/Z value	p
PHN incidence at D90	16/46 (34.8%)	8/49 (16.3%)	18.5% (1.2%, 35.7%)	2.733 (1.036, 7.215)	4.280	.033
PHN incidence at D180	12/41 (29.3%)	5/45 (11.1%)	18.2% (1.5%, 34.8%)	3.310 (1.051, 10.429)	4.460	.032

PHN: post herpetic neuralgia; PP: per protocol; D30: 1-month after last ultrasound (US)-guided thoracic paravertebral block (TPVB) injection; D90: 3-month after last US-guided TPVB injection; D180: 6-month after last US-guided TPVB injection.

Figure 4. The proportion of patients reporting problems in the EuroQoL EQ-5D domains at the time of day 0, 30, 90 and 180.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Professor Li Niu, upon reasonable request.