Management of Postherpetic Neuralgia with Intrathecal Methylprednisolone Vinaya K. Puppala , MD, Jessen Mukalel , MD, N. Nick Knezevic , MD, PhD, Kenneth D. Candido , MD Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657 USA. Abstract.
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Management of Postherpetic Neuralgia with Intrathecal MethylprednisoloneVinaya K. Puppala, MD, JessenMukalel, MD, N. Nick Knezevic, MD, PhD, Kenneth D. Candido, MDDepartment of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657 USA
We describe the case of an 80-year-old woman with debilitating postherpetic neuralgia (PHN) who failed to respond to conesrvative and interventional strategies. She elected to undergo treatment with intrathecal methyl-prednisolone (ITMP) under fluoroscopic guidance. Polyethylene glycol (PEG) concentration was reduced by inverting the vial of methylprednisolone acetate (MPA) for two hours and aspirating the partitioned steroid component only. Our patient was pain-free after the third intervention and is highly satisfied.
For patients refractory to other treatment modalities, our method of intrathecal intervention with preservative-free methylprednisolone should be considered as a potentially safe, practical, and efficacious treatment for postherpetic neuralgia.
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Figure 2. Photograph of inverted Depo-Medrol vial with red circle demonstrating partition of MPA steroid away from PEG preservative.
Figure 1. Photograph of patient’s painful PHN lesions over left thoracic T4-T5 dermatomal distribution