Abstract
Purpose Stellate ganglion (SG) block by thermal radiofrequency ablation (RFA) is frequently conducted as a therapeutic intervention for sympathetic-maintained and neuropathic pain syndromes. RFA’s partial lack of effectiveness could be partly due to the ablation zone (AZ) not completely covering the SG section and therefore preventing the ‘cutting’ of the afferent pathways. Our objective was to build a theoretical model to conduct computer simulations to assess the effect of the electrode position relative to the SG. Methods A three-dimensional model was built including the SG and adjacent tissues (vertebrae C7-T1-T2, trachea, carotid artery and vertebral artery). RFA (90-s, 80 °C) was simulated considering a 22 G-5 mm electrode. The AZ was computed using the 50 °C isotherm. Results An electrode displacement of 2 mm in any direction from the optimal position (centered on the SG) meant that the AZ did not fully cover the SG section. Likewise, SG size considerably affected the RFA effectiveness since the AZ fully covered the section of small but not large SGs. Conclusions The findings suggest that the currently used SG RFA settings (i.e., 22 G-5 mm electrode, 90-s, 80 °C) may not be appropriate due to their inability to achieve an AZ that fully covers the SG cross section under certain circumstances, such as a large SG and non-optimal positioning of the RF electrode with respect to the SG center.
Highlights
The stellate ganglion (SG), known as the cervico thoracic ganglion, is part of the sympathetic nervous system
SG blockade by means of local anesthetics has been conducted as a therapeutic intervention for a wide variety of sympathetic-maintained [3] and neuropathic pain syndromes, e.g., for complex regional pain syndrome [1], ventricular arrhythmias [4], cerebral vasoconstriction [5], and cancer pain [6]
This facilitates to notice those cases in which the ablation zone (AZ) completely occupies the SG cross section can be seen, suggesting that radiofrequency ablation (RFA) would be effective
Summary
The stellate ganglion (SG), known as the cervico thoracic ganglion, is part of the sympathetic nervous system. SG blockade by means of local anesthetics has been conducted as a therapeutic intervention for a wide variety of sympathetic-maintained [3] and neuropathic pain syndromes, e.g., for complex regional pain syndrome [1], ventricular arrhythmias [4], cerebral vasoconstriction [5], and cancer pain [6]. Percutaneous RFA of SG may be regarded as a continuous regional sympathetic block with long-term efficiency, improved safety, more precise localization, and less morbidity and mortality than surgical sympathectomy [10]
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