Is pre-op Acyclovir indicated in a patient with history of shingles in right T7 dermatome + post herpetic neuralgia (resolved), listed for lap chole?

21 January 2015 1 5K Report

A have encountered a patient in clinic who is being listed for an elective laparoscopic cholecystectomy for gallstone disease. 3 years ago she was treated for her first presentation of shingles, affecting the T7 dermatome. She suffered from very debilitating post-herpetic neuralgia, which has now resolved. She was left with macular areas of de-pigmentation in the right upper quadrant of the abdomen. As her shingles is over the dermatome in the RUQ, and considering peritoneal pain can be referred here, is there any indication for a pre-operative dose of IV acyclovir? Many thanks in advance

Ussamah El-khani

Thanks Efstratios. I guess another question would be: Is skin trauma or skin stretch a risk factor for shingles in a patient with a positive history. For a standard 4-port lap chole, 3 of my incisions will be in the directly affected area. If trauma/stretch is a reliable risk factor, there may be an emperical use of prophylactic acyclovir.

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