Postherpetic neuralgia (PHN) is a chronic pain syndrome associated with the reactivation of a primary infection with varicella-zoster. It is common with the intercostal nerve, which is easy to target and neurolysis. But PHN of L1 nerve dermatome is difficult to access for an isolated single nerve block. In our case, we had a 54-year-old male with severe L1 PHN (NRS pain score of 8–9/10), which was refractory to multiple drugs. A combined iliohypogastric/ilioinguinal nerve block did not produce any significant analgesic effect. We administered a transverse abdominis plane (TAP) block with a combination of local anesthetics and steroids to accomplish satisfactory analgesia. We repeated the block after 15 days to achieve an NRS pain score of 2/10 and later prescribed a minimal dose of duloxetine (10 mg once a day) only. The patient was followed up for 2 months with adequate pain relief. There were no side effects. We report this case to emphasize that fascial plane blocks could also prove fruitful in targeting specific nerves in cases of refractory PHN.
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