The "three-in-one block" for treatment of pain in a patient with acute herpes zoster infection.

Background and objectives: Herpes zoster 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 zoster 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.