I'm a 61 year old female on the immuno suppressant Imuran for Crohn's
disease and doing very well. In symptomatic remission and all blood
work has been good.

I recently developed a case of shingles after a week of severe aching
pain at the waistline, sometimes in the left flank, other times at the
left lower rib in back. One ER trip and morphine IV plus phenergan for
the morphine induced vomiting with an inconclusive Dx of constipation,
Crohn's, a 6cm ovarian cyst we've been watching for a year pushing on
a nerve or muscle. A second trip to ER two days later and more IV
morphine before the rash began to appear and a shingles Dx.

Immediately started on Valtrex 500 mg 2 x daily, Elavil 10 mg 1 x
daily, Neurontin tapering up to 300 mg 3 x daily, Hydrocodone/APAP
7.5/750 to be taken 1-2 tabs every 3-4 hours. Nerve blocks have been
suggested to prevent or reduce the 50% or greater chance of
postherpetic neuralgia.

I am terrified of sedation and not knowing what they are doing. I'm
even more terrified of a needle anywhere near my spine.

My rash is considerably milder than the horrible pictures I've seen on
the net. Its an intermittent series of rash from the left of my spine
to the left of my belly button. The burning or itching has pretty much
been non-existent, at least not real troublesome. An OTC 1% Menthol/1%
Pryamoxine hydrochloride cream is treating it very well and since the
rash erupted on Valentine's day has made the rash more and more pale
with only a few still angry red spots and no blistering or scabbing.

It seems that nerve blocks to lessen or prevent the occurance of PHN
are somewhat controversial or at least the results inconclusive with
no current research into their use to lessen or prevent the occurence
of PHN.

I would feel much better about deciding whether to undergo these
"preventive" nerve blocks if I could see a detailed video of one
actually being done. My fear of sedation and anesthesia is not not
waking up but rather not knowing what they are doing and having no say
in what they are doing. But my fear of a needle in or near my spine is
even greater. Just numbing my back wouldn't work. The minute someone
went behind me or I even felt the gauze alcohol swab on my back they
would have to peel me off the ceiling if I was even in the same room
at the time! More likely I'd be out the door!

Is the sedative given via IV?
How do they determine which nerve(s) to block?
Does the needle go in the spinal cord/column or into the nerve outside
of and next to the spine?
Is there a detailed, explicit video of the procedure available that I
could view before deciding?
Can you get spinal headaches from a nerve block?
What are the risks?
Given the simplicity of my rash as compared to pictures on the web
could that be any indication of less likelihood of my getting PHN?
Is the pain I experienced prior to onset of the rash any indication of
greater chances of developing PHN?

What other questions should I be asking? I've been told that the nerve
block(s) should be done before the rash is totally gone for best
results in preventing PHN.

I have done preliminary searches at PubMed and google using "shingles"
"postherpetic neuralgia" and "nerve block".

Is the sedative given via IV?
It would depend on the practitioner, but probably IV for a quicker
effect more dependably and on time.

How do they determine which nerve(s) to block?
The rash or the pain will be in a distibution consistent with 1-3
dermatomes, or bands- the nerves wrap around your tummy from the
backlike a band of sticky tape each corresponding to a spinal level. I
presume they would try to do the procedure in the dermatome in the
middle because strictly speaking the problem is just in one dermatome
or band.
I don't know much about nerve bocks so the question is what are they
proposing to do? Some attempt to block the actual sensory dorsal root
or a "Sympathetic" block blocking the sympathetic nerve plexus or
simply an epidural which may modulate root pain????????? An Epidural
is the most likely.

Does the needle go in the spinal cord/column or into the nerve outside
of and next to the spine?
Don't know what they are proposing but you can take it that it will be
outside of the spinal canal.

Is there a detailed, explicit video of the procedure available that I
could view before deciding?
Sorry, Don't know

Can you get spinal headaches from a nerve block?
If they enter the spinal canal inadvertantly...

What are the risks?
At a GUESS: Infection, Bleed, Pain and Discomfort, (All highly
unlikely), Procedure failure, Requirement for repeat, Weakness and
numbess in other levels

Given the simplicity of my rash as compared to pictures on the web
could that be any indication of less likelihood of my getting PHN?
I don't think it does. But a better indicator may be the absence of
burning pain at this stage.

Is the pain I experienced prior to onset of the rash any indication of
greater chances of developing PHN?
I don't think so,


_____________________________________
You could look at www.emedicine.com
http://www.emedicine.com/med/topic2361.htm for basic VZV information

Follow this link which explains the rationale of these treatments
which appear to be epidural attempts, in which case they may have the
adverse effect of tracking down the epidural space and therefore
leaving you a little numb/weak for a while
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15005813

These are the combined results for a PHN AND in PUBMed

1:  Mizuno J, Sugimoto S, Ikeda M, Kamakura T, Machida K, Kusume S. 
[Treatment with stellate ganglion block, continuous epidural block and
ulnar nerve block of a patient with postherpetic neuralgia who
developed complex regional pain syndrome (CRPS)]
Masui. 2001 May;50(5):548-51. Japanese. 
PMID: 11424478 [PubMed - indexed for MEDLINE] 

2:  Wu CL, Marsh A, Dworkin RH. 
 The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia.
Pain. 2000 Aug;87(2):121-9. Review. 
PMID: 10924805 [PubMed - indexed for MEDLINE] 

3:  Boas RA. 
 Sympathetic nerve blocks: in search of a role.
Reg Anesth Pain Med. 1998 May-Jun;23(3):292-305. Review. 
PMID: 9613543 [PubMed - indexed for MEDLINE] 

If you use the term PHN you will find more in Pubmed than by using
Post herpetic Neuralgia

____________________________________

You need to find a good Anaethesiologist and ask their opinion. You
need to bare in mind that this is a treatment for which there is no
good evidence and which is operator dependant. However as a recent BMJ
article suggested, you don't need the proof of an evidence base to use
a Parachute.... :)
Write your questions down, they won't mind.