Comparative Effectiveness Of Ultrasound-Guided Erector Spinae Plane Block And Intercostal Nerve Block In Acute Thoracic Herpetic Neuralgia Management

Abstract

Herpes zoster (HZ) is frequently associated with acute herpetic neuralgia (AHN), a painful condition that can progress to post-herpetic neuralgia (PHN), one of the most challenging chronic pain syndromes. Effective early management of AHN is essential to improve patient outcomes and reduce the risk of PHN. Regional analgesic techniques such as ultrasound-guided erector spinae plane block (ESPB) and intercostal nerve block (ICNB) have emerged as promising interventions alongside conventional pharmacological therapy. This review summarizes the current evidence on the comparative effectiveness of ESPB and ICNB in AHN, highlighting their mechanisms, clinical applications, and reported outcomes in terms of pain reduction, functional recovery, and prevention of PHN. Emerging studies suggest that both blocks provide meaningful analgesia, with ESPB demonstrating potential advantages in sustained pain relief and reduced analgesic requirements. While evidence remains limited, these techniques represent valuable additions to multimodal pain strategies, and further research is warranted to establish optimal protocols and long-term benefits.