{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:20:54Z","timestamp":1780550454361,"version":"3.54.1"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Shingles is a common global disease, with the chest region being one of its most frequently affected areas. Postherpetic neuralgia (PHN) is one of the most common and debilitating complications of this disease, characterized by high incidence, prolonged duration, and treatment resistance, severely affecting patients\u2019 daily life and quality of life. Currently, research on the prevention of PHN remains limited. Nerve block, as a promising intervention, has been widely applied in clinical pain management. However, there is still no consensus on the efficacy and safety of different nerve block techniques for the prevention of chest-related PHN, warranting further systematic evaluation and comparison.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A network meta-analysis was conducted using RevMan 5.4 and Stata 18.0, analyzing data from nine studies retrieved from four English-language databases: MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>This study included a total of 9 randomized controlled trials, involving 741 patients with chest herpes zoster and 8 different interventions. The results of the network meta-analysis indicated that the top three interventions in terms of total effective rate were: PVB: Amide local anesthetics + Methylene blue &amp;gt; PVB: Methylene blue &amp;gt; ESPB: Amide local anesthetics + Glucocorticoid. In terms of pain level, as assessed by the Visual Analogue Scale, the top three interventions were: PVB: Amide local anesthetics + Glucocorticoid &amp;gt; PVB: Amide local anesthetics &amp;gt; ESPB: Amide local anesthetics + Glucocorticoid.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results of this study indicate that PVB is superior to ESPB in both reducing VAS scores and improving the total effective rate. Among the interventions, PVB: Amide local anesthetics + Methylene blue demonstrated the best performance in terms of total effective rate, while PVB: Amide local anesthetics + Glucocorticoid showed the most significant effect in reducing VAS scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p><jats:uri>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:uri>, identifier CRD42024604329.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1612871","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T04:10:15Z","timestamp":1755490215000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative effectiveness of nerve block strategies for preventing postherpetic neuralgia in thoracic herpes zoster: a network meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Wensheng","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengze","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaozu","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1056\/NEJMc1310369","article-title":"Herpes zoster","volume":"369","author":"Hirschmann","year":"2013","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"Itc 19","DOI":"10.7326\/AITC201808070","article-title":"Herpes zoster","volume":"169","author":"Schmader","year":"2018","journal-title":"Ann Intern Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"251","DOI":"10.4103\/ijdvl.IJDVL_1021_16","article-title":"Epidemiology, treatment and prevention of herpes zoster: a comprehensive review","volume":"84","author":"Koshy","year":"2018","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"596","DOI":"10.3390\/pathogens13070596","article-title":"Herpes zoster and post-herpetic neuralgia-diagnosis, treatment, and vaccination strategies","volume":"13","author":"Lim","year":"2024","journal-title":"Pathogens"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"Cd010958","DOI":"10.1002\/14651858.CD010958.pub2","article-title":"Topical lidocaine for neuropathic pain in adults","volume":"2014","author":"Derry","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e164","DOI":"10.1371\/journal.pmed.0020164","article-title":"Analgesic therapy in postherpetic neuralgia: a quantitative systematic review","volume":"2","author":"Hempenstall","year":"2005","journal-title":"PLoS Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1645","DOI":"10.1016\/j.vaccine.2014.01.058","article-title":"Cost-effectiveness of vaccination against herpes zoster and postherpetic neuralgia: a critical review","volume":"32","author":"Kawai","year":"2014","journal-title":"Vaccine"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"509","DOI":"10.3344\/kjp.2021.34.4.509","article-title":"Pharmacological and non-pharmacological strategies for preventing postherpetic neuralgia: a systematic review and network meta-analysis","volume":"34","author":"Kim","year":"2021","journal-title":"Korean J Pain"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"177","DOI":"10.3344\/kjp.2015.28.3.177","article-title":"Herpes zoster and Postherpetic neuralgia: practical consideration for prevention and treatment","volume":"28","author":"Jeon","year":"2015","journal-title":"Korean J Pain"},{"key":"ref10","first-page":"E1109","article-title":"The effect of erector spinae plane blockade on prevention of postherpetic neuralgia in elderly patients: a randomized double-blind placebo-controlled trial","volume":"24","author":"Lin","year":"2021","journal-title":"Pain Physician"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1111\/papr.12179","article-title":"Single paravertebral injection for acute thoracic herpes zoster: a randomized controlled trial","volume":"15","author":"Makharita","year":"2015","journal-title":"Pain Pract"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"g7647","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"350","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"101260","DOI":"10.1016\/j.ctcp.2020.101260","article-title":"Comparative effectiveness of breathing exercises in patients with chronic obstructive pulmonary disease","volume":"41","author":"Marotta","year":"2020","journal-title":"Complement Ther Clin Pract"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1056\/NEJMcp1403062","article-title":"Clinical practice. Postherpetic neuralgia","volume":"371","author":"Johnson","year":"2014","journal-title":"N Engl J Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2249","DOI":"10.1016\/j.pain.2013.06.004","article-title":"Interventional management of neuropathic pain: Neu PSIG recommendations","volume":"154","author":"Dworkin","year":"2013","journal-title":"Pain"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2085","DOI":"10.1177\/0300060517710068","article-title":"Thoracic paravertebral block versus intravenous patient-controlled analgesia for pain treatment in patients with multiple rib fractures","volume":"45","author":"Yeying","year":"2017","journal-title":"J Int Med Res"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"517","DOI":"10.4103\/0970-9185.74599","article-title":"Methylene blue: revisited","volume":"26","author":"Ginimuge","year":"2010","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"387","DOI":"10.2147\/JPR.S84685","article-title":"Evaluation of the protein biomarkers and the analgesic response to systemic methylene blue in patients with refractory neuropathic pain: a double-blind, controlled study","volume":"8","author":"Miclescu","year":"2015","journal-title":"J Pain Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"E1189","DOI":"10.36076\/ppj\/2016.19.e1189","article-title":"Clinical evaluation and magnetic resonance imaging assessment of intradiscal methylene blue injection for the treatment of discogenic low back pain","volume":"19","author":"Zhang","year":"2016","journal-title":"Pain Physician"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"811","DOI":"10.5137\/1019-5149.JTN.24950-18.2","article-title":"Clinical study of ultrasound-guided methylene blue thoracic paravertebral nerve block for the treatment of Postherpetic neuralgia","volume":"29","author":"Zhao","year":"2019","journal-title":"Turk Neurosurg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.bbi.2017.04.020","article-title":"Methylene blue attenuates neuroinflammation after subarachnoid hemorrhage in rats through the Akt\/GSK-3\u03b2\/MEF2D signaling pathway","volume":"65","author":"Xu","year":"2017","journal-title":"Brain Behav Immun"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"5137","DOI":"10.1007\/s12035-017-0712-2","article-title":"From mitochondrial function to neuroprotection-an emerging role for methylene blue","volume":"55","author":"Tucker","year":"2018","journal-title":"Mol Neurobiol"},{"key":"ref23","first-page":"102","article-title":"Herpes zoster and postherpetic neuralgia: diagnosis and therapeutic considerations","volume":"11","author":"Roxas","year":"2006","journal-title":"Altern Med Rev"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2566","DOI":"10.1038\/s41467-019-10296-9","article-title":"Polymer-tetrodotoxin conjugates to induce prolonged duration local anesthesia with minimal toxicity","volume":"10","author":"Zhao","year":"2019","journal-title":"Nat Commun"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1038\/s41551-021-00793-y","article-title":"Delivery of local anaesthetics by a self-assembled supramolecular system mimicking their interactions with a sodium channel","volume":"5","author":"Ji","year":"2021","journal-title":"Nat Biomed Eng"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1097\/j.pain.0000000000000307","article-title":"A systematic review and meta-analysis of risk factors for postherpetic neuralgia","volume":"157","author":"Forbes","year":"2016","journal-title":"Pain"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"471","DOI":"10.36076\/ppj.2017.20.5.471","article-title":"The effect of early use of supplemental therapy on preventing Postherpetic neuralgia: a systematic review and meta-analysis","volume":"20","author":"Xing","year":"2017","journal-title":"Pain Physician"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"R6","DOI":"10.1007\/BF03018333","article-title":"Paravertebral anesthesia and analgesia","volume":"51","author":"Richardson","year":"2004","journal-title":"Can J Anesth"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1016\/j.pmr.2014.02.001","article-title":"Epidural steroid injections for radicular lumbosacral pain: a systematic review","volume":"25","author":"Shamliyan","year":"2014","journal-title":"Phys Med Rehabil Clin N Am"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"102","DOI":"10.4103\/joacp.JOACP_70_19","article-title":"Comparison of morphine, dexmedetomidine and dexamethasone as an adjuvant to ropivacaine in ultrasound-guided supraclavicular brachial plexus block for postoperative analgesia-a randomized controlled trial","volume":"37","author":"Venkatraman","year":"2021","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.jclinane.2017.02.004","article-title":"Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: a randomized, double-blinded clinical trial","volume":"38","author":"Sakae","year":"2017","journal-title":"J Clin Anesth"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1016\/j.neuchi.2019.06.007","article-title":"A clinical study of paraspinal nerve block on treatment of herpes zoster under ultrasonic guidance","volume":"65","author":"Zhao","year":"2019","journal-title":"Neurochirurgie"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1080\/07853890.2022.2031267","article-title":"A prospective randomized comparison of the efficacy of standard antiviral therapy versus ultrasound-guided thoracic paravertebral block for acute herpes zoster","volume":"54","author":"Ma","year":"2022","journal-title":"Ann Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"811298","DOI":"10.3389\/fneur.2022.811298","article-title":"Pulsed radiofrequency combined with methylene blue paravertebral nerve block effectively treats thoracic postherpetic neuralgia","volume":"13","author":"Ji","year":"2022","journal-title":"Front Neurol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1080\/11101849.2021.1955517","article-title":"Role of ultrasound guided erector spinae plane block in management of acute herpes zoster pain and incidence of post-herpetic neuralgia","volume":"37","author":"El-Sayed","year":"2021","journal-title":"Egypt J Anaesth"},{"key":"ref36","first-page":"E977","article-title":"Ultrasound-guided erector spinae block versus ultrasound-guided thoracic paravertebral block for pain relief in patients with acute thoracic herpes zoster: a randomized controlled trial","volume":"25","author":"Abdelwahab","year":"2022","journal-title":"Pain Physician"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1007\/s40122-021-00265-w","article-title":"Ultrasound-guided continuous thoracic paravertebral infusion of methylene blue in the treatment of postherpetic neuralgia: a prospective, randomized, controlled study","volume":"10","author":"Wang","year":"2021","journal-title":"Pain Ther"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"510","DOI":"10.4103\/joacp.joacp_82_23","article-title":"A randomized clinical trial comparing the efficacy of ultrasound-guided erector spinae block and paravertebral block in preventing postherpetic neuralgia in patients with zoster-associated pain","volume":"40","author":"Patil","year":"2024","journal-title":"J Anaesthesiol Clin Pharmacol"}],"updated-by":[{"DOI":"10.3389\/fneur.2025.1697557","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000}}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1612871\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T09:37:48Z","timestamp":1758015468000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1612871\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,18]]},"references-count":38,"alternative-id":["10.3389\/fneur.2025.1612871"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1612871","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,18]]},"article-number":"1612871"}}