Cholecystitis after repeated sympathetic blocks for post-herpetic neuralgia

Postherpetic neuralgia (PHN) is associated with increasing age. Medications are the mainstay of treatment. Sympathetic nerve blocks are performed in the early phase or when the response to medication is poor. We report on a 79-year-old man with PHN on the right side with a T8 to T11 dermatomal distribution. The patient experienced dysesthesia and aching in the involved area. The verbal analog score (VAS) was 5-6 on a 0-10 digit scale. The patient also suffered from severe sleep disturbance and thoughts of death due to insomnia. Treatment with repeated epidural sympathetic nerve blocks was satisfactory with a VAS of 0-3. However, vague right subcostal pain developed after the interventions. An abdominal echogram revealed 3 gallstones in the gall bladder. A laparoscopic cholecystectomy was performed a week later. After the operation, the patient received medication for the mild dysesthetic pain for another 11 months with complete remission. We propose that potential complications can occur when sympathetic nerve blocks are used in a patient with preexisting gallstones. We also emphasize the possibility of another etiology when there is a change of the character of pain.