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Yamanaka D, Kawano T, Shigematsu-Locatelli M, et al. Peripheral nerve block with a high concentration of tetracaine dissolved in bupivacaine for intractable post-herpetic itch: a case report. JA Clin Rep. 2016;2(1):43doi: 10.1186/s40981-016-0069-y.
Yamanaka, D., Kawano, T., Shigematsu-Locatelli, M., Nishigaki, A., Kitamura, S., Aoyama, B., Tateiwa, H., Kitaoka, N., & Yokoyama, M. (2016). Peripheral nerve block with a high concentration of tetracaine dissolved in bupivacaine for intractable post-herpetic itch: a case report. JA clinical reports, 2(1), 43. https://doi.org/10.1186/s40981-016-0069-y
Yamanaka, Daiki, et al. "Peripheral nerve block with a high concentration of tetracaine dissolved in bupivacaine for intractable post-herpetic itch: a case report." JA clinical reports vol. 2,1 (2016): 43. doi: https://doi.org/10.1186/s40981-016-0069-y
Yamanaka D, Kawano T, Shigematsu-Locatelli M, Nishigaki A, Kitamura S, Aoyama B, Tateiwa H, Kitaoka N, Yokoyama M. Peripheral nerve block with a high concentration of tetracaine dissolved in bupivacaine for intractable post-herpetic itch: a case report. JA Clin Rep. 2016;2(1):43. doi: 10.1186/s40981-016-0069-y. Epub 2016 Dec 05. PMID: 29492438; PMCID: PMC5813738.
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JA Clin Rep. 2016;2(1):43. doi: 10.1186/s40981-016-0069-y. Epub 2016 Dec 05.

Peripheral nerve block with a high concentration of tetracaine dissolved in bupivacaine for intractable post-herpetic itch: a case report.

JA clinical reports

Daiki Yamanaka, Takashi Kawano, Marie Shigematsu-Locatelli, Atsushi Nishigaki, Sonoe Kitamura, Bun Aoyama, Hiroki Tateiwa, Noriko Kitaoka, Masataka Yokoyama

Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan.

PMID: 29492438 PMCID: PMC5813738 DOI: 10.1186/s40981-016-0069-y

Abstract

BACKGROUND: Post-herpetic itch (PHI) is a neuropathic itch syndrome following herpes zoster. It has been reported that PHI is occasionally sufficiently severe to compromise patients' quality of life and frequently refractory to treatment. Here, we present a case of severe chronic PHI successfully treated with supraorbital nerve block using a high concentration of tetracaine dissolved in bupivacaine.

CASE PRESENTATION: An 82-year-old man presented with severe chronic itching in the ophthalmic branch of the left trigeminal nerve dermatome, following acute herpes zoster. The patient's itching was unresponsive to usual medical treatments for PHI including antiepileptic drugs, topical capsaicin cream, and supraorbital nerve radiofrequency thermo-coagulation. Topical lidocaine cream could relieve the itching, but could not provide long-term relief of itching and thus failed to achieve a satisfactory result. After these conventional treatments, left supraorbital nerve block using 4% tetracaine dissolved with 0.5% bupivacaine was conducted. Afterwards, the patient experienced long-lasting resolution of the itching with improvement of sleep disturbance. A transient, mild edema of the eyelids occurred, but there were no other complications.

CONCLUSIONS: Peripheral nerve block using 4% tetracaine dissolved with 0.5% bupivacaine was beneficial in relieving PHI in the ophthalmic division of the trigeminal nerve.

Keywords: Peripheral nerve block; Post-herpetic itch; Tetracaine

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