Background Post-herpetic itching [PHI] was found in four percent of all herpes zoster patients. They may even describe this itching complaint without any pain. It may not respond to regular anti-pruritus drugs or anti-histaminics. Sympathetic nerve block has been used with different degrees of success as a component of therapy for post-herpetic neuralgia [PHN] in cranial, cervical, thoracic, and lumbar distributions. Sacral dermatomal involvement of PHN occurs in only three percent of patients.Findings A 40-year-old female patient had a complaint of intractable sacral itching. She had a total colectomy operation one year ago. At the early postoperative period, vesicular lesions appeared at the sacral region. These vesicular lesions were completely healed after anti-viral medications. However, the complaint of itching started thereafter. The patient was treated with various anti-itching medical therapies at different hospitals. We started gabapentin by increasing the dose from 1.8 to 2.4 mg/day. With a partial response to this medical treatment, impar ganglion blockage was performed five times with two- or three-day intervals in a two-week period. After six months, the itching had completely subsided without any recurrence.Conclusions Clinical experiences show that the treatment of neuropathic itching is far more difficult than neuropathic pain. Sympathetic nerve blocks can also be combined with medical treatments. Impar ganglion block has an important role in the early aggressive treatment of zona at sacral dermatome. There are very rare cases in the literature showing that PHI can be treated with a sympathetic block.