The ''three-in-one block'' for treatment of pain in a patient with acute Herpes Zoster infection

Background and Objectives. Herpes tester infection in elderly patients frequently results in disabling pain, carries a high risk of postherpetic neuralgia (PHN), and can pose a significant therapeutic challenge. Methods. We describe a successful use of the perivascular technique of lumbar plexus blockade (''three-in-one block'') for treatment of pain during acute herpes tester infection in an 82-year-old severely ill patient in whom other modalities were contraindicated. Results. Three-in-one block using 40 mL of 0.25% bupivacaine with 1:300,000 epinephrine resulted in excellent pain relief that lasted for 2 weeks. Conclusions. The perivascular technique of lumbar plexus blockade may be a useful alternative to epidural and paravertebral techniques of lumbar blockade in the occasional patient for whom these other approaches are contraindicated.