Facial Ramsay-Hunt Shingles -Paralysis Maybe Adverted by Stellate Ganglion Block

Ramsay Hunt syndrome shingles affects ear canal and associated area about ear, and is very painful and can be associated with facial nerve damage. Two stellate ganglion blocks with “local anesthetic 0.25% bupivacaine and triamcinolone 40 mg were given daily for two sittings. Next five sittings of block were done with 0.25% bupivacaine only” – pain subsided after 2-3 days.

Saudi J Anaesth. 2015 Apr-Jun;9(2):204-6. doi: 10.4103/1658-354X.152889.
Stellate ganglion block can relieve symptoms and pain and prevent facial nerve damage.
Gogia AR, Chandra KN
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374230/

ramsay_hunt

 

 

 

 

 

 

  • given Valtrex 1 gm tid,  Clavulin, Prednisone 60 mg/day , and tramadol
  • mentioned potential use of gabapentin(think pregabalin would be better tolerated at this age)
  • “0.25% bupivacaine and triamcinolone 40 mg were given daily for two sittings. Next five sittings of block were done with 0.25% bupivacaine only. Pain was gone after first 2-3 shots”

Comment – facial shingles is a horrible disease and Ramsay-hunt can cause facial paralysis. I would be giving daily b12 shots as it improves nerve recovery after bell’s palsy in 2 Chinese studies. Vitamin c 500 mg bid would be helpful as well as per prior writeup. The ear canal is helped by burosol wicks or drops.

More than the two stellate blocks seems like a little overkill as pain was mostly gone by 2 shots. Stellate blocks are dangerous and there is a shift to doing them under untrasound control but even then, cervical blood vessel penetration can cause seizures. They used to think if you twisted the needle and pulled back, you could tell if you were in a vessel when you did this procedure, but that was proved wrong by one incident. Getting an anesthetist to do it, is like pulling teeth and I can’t blame them. However,  it still would be worthwhile to twist arms… Any comments?

 

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