Effectiveness of Ultrasonography-Guided Serratus Posterior Superior Intercostal Plane Block in Thoracic Postherpetic Neuralgia: A Retrospective Cohort Study

After obtaining approval from the relevant ethics committee (University of Health Sciences, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, KAEK/2025.05.139), patients over 18 years of age who underwent a single-session ultrasound (US)-guided serratus posterior superior intercostal plane block (SPSIPB) in the thoracic region (T1-T10 dermatomes) due to PHN between June 2023 and February 2025 were retrospectively evaluated. SPSIPB was performed in patients whose complaints persisted despite existing medical treatments. The study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all patients enrolled in the study, which was carried out at the pain clinic of a tertiary care hospital. This retrospective, single-center cohort study was designed. A total of 34 patients who met the inclusion criteria were included in the study . Patients were excluded if they had cervical disc herniation; a history of trauma or surgery involving the neck, shoulder, or back; malignancy; kyphoscoliosis; a history of inflammatory diseases (e.g., rheumatoid arthritis, ankylosing spondylitis); congenital spinal anomalies; neck pain accompanied by neurological deficits; pregnancy; mental or psychotic disorders; hematologic diseases causing bleeding or coagulation disorders; use of antiplatelet or anticoagulant drugs or medications predisposing to bleeding; severe systemic infections such as sepsis; local infections at the planned intervention site; known allergies to any of the drugs to be used; or a history of invasive procedures for PHN in the thoracic region within the past 3 months. Data Collection and Assessment Scales The following data were collected: Age, gender, body mass index (BMI), affected side in PHN, duration of PHN and affected dermatome, history of HZ vaccination (live/recombinant), data regarding immunosuppression (Human Immunodeficiency Virus, active cancer, high-dose steroids), PHN family history, level of procedure performed, complications, Numeric Rating Scale-11 (NRS-11), Neuropathic Pain Questionnaire (DN4), Short Form-12 (SF-12) quality of life index subscores and average daily tramadol (mg/day) consumption before and 1 and 3 months after the procedure were recorded. Medication Management Patients' gabapentinoids and antidepressants (amiltriptyline, duloxetine, etc.) used for PHN were continued. Tramadol doses were either increased or decreased for pain control after SPSIPB. Total daily average tramadol consumption was recorded before, at the end of the first and third months after the procedure.