1. 2022;25;365-372The Effect of Erector Spinae Plane Block With and Without Addition of Magnesium on Relief of Pain from Post-herpetic Neuralgia
   Randomized Controlled Trial
   Sameh Abdelhalik Ahmed, MD, Amr Ahmed Magdy, MD, Mohammad Ali Abdullah, MD, and Amr Arafa Albadry, MD.

BACKGROUND: The best tool for management of postherpetic neuralgia (PHN) is a matter of debate. The use of ultrasound-guided erector spinae plane block (ESPB) in patients with PHN may decrease pain severity and the need for analgesics.

OBJECTIVES: The objective of this clinical study was to test the efficacy of ESPB with and without the addition of magnesium sulphate on pain control and analgesic consumption in patients with PHN.

STUDY DESIGN: Randomized controlled double-blinded trial.

SETTING: A single university center.

METHODS: A total of 75 patients with PHN were included in the study. Patients were randomly divided into 3 equal groups. Group A received sham ESPB (2 mL normal saline), Group B received ESPB with 20 mL of bupivacaine (0.25%), and Group C received ESPB with 20 mL of bupivacaine (0.25%) and 100 mg magnesium sulphate. All patients received standard medical care. The pain score, the consumption of pregabalin and acetaminophen, the incidence of complications, and the patient’s satisfaction were measured and recorded.

RESULTS: In comparison to the control group, the use of real ESPB with or without the addition of magnesium significantly decreased the Numeric Rating Scale score for pain during the first week of follow-up (P < 0.05); decreased the mean daily consumption of pregabalin and acetaminophen from the third to the twelfth week of follow-up (P < 0.05); and increased the level of patients’ satisfaction (P = 0.03). The addition of magnesium sulphate showed an insignificant difference in comparison to the use of bupivacaine alone in ESPB (P ? 0.05).

LIMITATIONS: The study was limited by being a singlecenter study, using a single-level injection, and using a single volume of local anesthetic mixture.

CONCLUSION: ESPB with or without adding magnesium sulphate is an effective pain management tool for cases of PHN. It leads to a significant decrease in pain score and analgesic requirements.

KEY WORDS: Post-herpetic neuralgia, erector spinae plane, thoracic, lumbar, magnesium, pain score, pregabalin, paracetamol