Abstract
About 40% of herpes zoster involves head and neck. Stellate ganglion block at the 6th or 7th cervical transverse process using 5 to 10ml of local anesthetics is adopted in Japan. Stellate ganglion block with this small dose of local anesthetics can relieve acute herpetic pain involving trigeminal region; however, it is hard to lessen acute herpetic pain involving the 6th cervical dermatome or lower. Preganglionic sympathetic fibers to the head and neck originate in the first to fourth thoracic segments. High thoracic epidural block covering these segments gives the same effects obtained by stellate ganglion block. Even severe acute herpetic pain involving head and neck can be relieved by continuous high thoracic epidural block. Stellate ganglion block has no effects on established postherpetic neuralgia itself. Relief of postherpetic neuralgia after stellate ganglion blocks may be caused by systemic effect of absorbed local anesthetics. Tricyclic antidepressant is the treatment of first choice for the treatment of established postherpetic neuralgia.
