Cervical Sympathetic Blockade Research Articles

Cervical Sympathetic Blockade Produces a Significant Reduction in Suicidal Ideation in a PTSD Cohort: A Case Series of 254 Patients

Background: Suicide is estimated to account for 1.4% of deaths worldwide, making it among one the leading causes of premature death. Stellate ganglion block (SGB) has been shown to reduce suicidal ideation in a single case report of a patient with comorbid post-traumatic stress disorder (PTSD) and suicidal ideation. Aims: To report a significant reduction of suicidal ideation using cervical sympathetic block (CSB), a more advanced version of SGB, in a cohort of patients with PTSD. Methods: 254 patients were evaluated for suicidal ideation via pre- and post-suicide risk assessments by using the Depressive Symptom Index - Suicidality Subscale (DSI-SS) as part of a pre- and post-treatment clinical interview. Further included were other psychiatric measures. Patients received CSB as per clinic protocol. Results: Overall, the patients had an average DSI-SS reduction of 43.8%, PCL-5 reduction of 31.7%, GAD-7 reduction of 22.5%, and PHQ-9 reduction of 35.5%, following CSB. Limitations: Lack of control, given this is an open-labeled, case series study. Conclusion: Cervical sympathetic block is a safe and minimally invasive procedure that may provide significant reduction in suicidal ideation as well as symptoms of PTSD.

Ketamine plus Cervical Sympathetic Blockade (CSB) Seems to be Significantly More Effective in Reducing the Symptoms of PTSD and Depression than CSB alone in a PTSD Cohort

Purpose: A significant number of Americans have symptoms of Post-Traumatic Stress Disorder (PTSD) and depression. Cervical sympathetic block (CSB) combined with sub-anesthetic ketamine infusions (KI) have been shown to reduce the symptoms of PTSD and depression via a synergistic effect. We aim to report a significant improvement of PTSD and depressive symptoms by concordant use of CSB and KI as compared to CSB alone. Methods: 26 consecutive patients were recruited to study the effects of KI and bilateral CSB vs bilateral CSB alone on sleep via a WHOOP band analysis. Patients were randomized to receive CSB alone vs KI and CSB. Patients received KI and CSB via clinic protocol. Results: Patients (n=11) that received CSB only, demonstrated a PCL reduction of 56.1% and BDI reduction of 59.5%. Patients (n=12) that received CSB and KI together, demonstrated a PCL reduction of 76.9% and a BDI reduction of 83.7%. Conclusion: Bilateral CSB combined with KI seems to be more effective in treating PTSD and depression symptoms as compared to bilateral CSB alone. Considering the size of the study, a larger scale evaluation would be necessary to confirm our findings.

Efficacy of Right-Sided Cervical Sympathetic Block in Treating Post-Traumatic Stress Disorder in Australian Cohorts: A Retrospective Analysis

Background: Post-traumatic stress disorder (PTSD) is a prevalent and debilitating condition in Australia. Success rates for current therapies may be delayed and inconsistent. This has led clinicians to explore other options, with cervical sympathetic blockade (CSB) being one of potential promise due to its high efficacy and rapid therapeutic onset. The original paper describing CSB was published in the United States of America (USA), and this was followed by multiple reports of successful PTSD treatment using stellate ganglion block (SGB). To date, no report of CSB utility in Australia has entered the medical literature. Objective: To evaluate the efficacy of CSB as a treatment option for patients diagnosed with PTSD in multiple Australian cohorts. Study Design: Retrospective cohort study. Setting: An established anesthesia pain clinic in 4 Australian cities (Sydney, Brisbane, Perth, Melbourne). Methods: The total cohort included 99 consecutive cases of patients diagnosed with PTSD and treated with right-sided CSB, performed by eight providers across 4 cities (Sydney, Brisbane, Perth, Melbourne). The primary outcome measurement was the PTSD Checklist Score version DSM-5 (PCL-5), which established the initial diagnosis of PTSD. PCL-5 data collection commenced in July 2021 and data regarding trauma specifications was collected beginning in July 2022. Patient demographic and clinical information collected included age, gender, and type of trauma experienced. Results: After the exclusion of cases due to missing data points, 99 patients were included in the final statistical analysis, having completed PCL-5 pre and post-CSB, between 7 and 30-days post-intervention. The patient population included civilian men (n=49) and civilian women (n=50). We identified 22 types of self-reported trauma leading to PTSD. The average decrease in PCL scores for men and women was 23.69 and 21.64, respectively. Statistically significant improvements in PTSD symptoms were noted across varying sources of causative trauma type and gender. Limitations: Limitations include the limited scope of observation giving exclusive focus on pre-and post-PCL data, the limited duration of observation, the self-reported nature of the patient-provided data, and the provision of treatment by eight physicians across multiple locations. Conclusion: CSB seems to be an effective treatment for PTSD symptoms irrespective of gender, trauma type, PTSD-related drug use, suicide attempt, or age, in Australian cohorts.

A review of the use of stellate ganglion block in the treatment of PTSD.

Current treatments for PTSD are often not effective or acceptable to the patient. There are a number of emerging new treatments. One promising new one is stellate ganglion block, an anesthetic treatment for pain which relieves symptoms of severe and chronic PTSD in some patients. The focus of this chapter is to summarize clinical evidence available for the effectiveness of cervical sympathetic ganglion injection called stellate ganglion block (SGB), as well as demonstrate possible clinical applications of its use. Cervical sympathetic blockade involves injecting a local anesthetic next to a group of nerves (ganglion) in the neck. The technique has been used clinically since 1925 with very few side effects. Finally, the neurobiology of SGB is discussed. Challenges to the use of SGB include the lack of randomized clinical trials and practitioners familiar with the use of SGB for PTSD.

(454) Cervical sympathetic blockade for the management of electrical storm

(454) Cervical sympathetic blockade for the management of electrical storm

Role of Continuous High Thoracic Epidural Anesthesia in Hippocampal Apoptosis after Global Cerebral Ischemia in Rats

Background: Cervical sympathetic blockade has been found to reduce cerebral vascular resistance and improve focal cerebral ischemia/reperfusion injury. In this study, we tested the hypothesis that the sympathetic blockade of high thoracic epidural anesthesia (HTEA) would reduce hippocampal apoptosis after global cerebral ischemia (GCI) injury. Methods: Fifteen-minute global ischemia was established by 4-vessel occlusion in adult male Wistar rats. And 0.5% bupivacaine or 0.9% saline (20 μl//h) was infused continuously to the thoracic epidural space through the T4-5 intervertebral space from 15 minutes before ischemia to 24 hours or 72 hours after ischemia. Cerebral blood flow (CBF), Mortality, neurodeficit scores (NDS), Nissl and TUNEL staining, hippocampal superoxide dismutase (SOD) activity, malondialdehyde (MDA) concentrations, western blot of poly (ADP-ribose) polymerase (PARP) and immunohistochemical staining (PARP, Bax and Bcl-2) were determined. Results: Both the hyperpefusion and hypoperfusion after reperfusion were improved by HTEA. HTEA decreased the number of apoptotic neurons in cornu ammonis area 1 (CA1), reduced PARP and Bax expressions with a decrease of Bax/Bcl-2 ratio induced by ischemic injury. The upregulation of SOD activity and the downregulation of MDA were obvious in the HTEA group compared with the GCI group. HTEA also improved NDS but not the mortality rate. Conclusion: Our study demonstrated that continuous HTEA attenuates hippocampal apoptosis and a behavioral deficit after global cerebral ischemia, and that these protective effects are associated with the improved microcirculation, reduced oxidative stress and the less activation of PARP.

A Review of the Stellate Ganglion Block/Cervical Sympathetic Block on the Prevention and Therapy of Cerebral Vasospasm After Subarachnoid Hemorrhage

One of the most dangerous and distressing complications of subarachnoid hemorrhage is the development of delayed cerebral ischemia from cerebral vasospasm. Although the exact mechanism causing cerebral vasospasm remains unclear, current evidence suggests that breakdown products of blood within the subarachnoid space may interact with the sympathetic innervation of the cerebral vasculature to produce vasoconstriction. Therefore, a novel treatment that would lessen these sympathetic effects may be beneficial to patients with cerebral vasospasm. This review will examine the potential benefit to neuro-critical care medicine that ultrasound-guided cervical sympathetic blockade, also known as the stellate ganglion block, could have on cerebral vasospasm.

Cervical Sympathetic Blockade in a Patient with Post-Traumatic Stress Disorder: A Case Report

(2008). Cervical Sympathetic Blockade in a Patient with Post-Traumatic Stress Disorder: A Case Report. Annals of Clinical Psychiatry: Vol. 20, No. 4, pp. 227-228.

An Unusual Etiology Of Vascular Toxicity And Its Treatment With Cervical Sympathetic Blockage

Gemcitabine is a nucleoside analogue used commonly in chemotherapy for solid tumors. One of its common side effects is vascular toxicity. Case due to Gemcitabine therapy is a urethral carcinoma. The patient was admitted with muscle pain in upper extremity of his finger with movement, sensitiveness, hypoesthesia, pallor, and cyanosis during the second cure of Gemcitabine treatment. After he was diagnosed with microangiopathy due to Gemcitabine, vasodilatation therapy and ten sets of cures of cervical sympathetic blockage were applied. Following the treatment, sign and symptoms disappeared dramatically. With regard to this case we believe that cervical sympathetic blockade is valuable as surgical sympathectomy in early stages of convenient cases.

Commentary

Dorsal sympathectomy and the management of the thoracic outlet syndrome have been considerably improved with the use of video assistance because it affords both magnification and an improved light system. Two techniques of video assistance were employed in the group of patients described here. One involved the sympathectomy done through three ports using standard video-assisted thoracic surgical methods. The second technique involved a transaxillary incision with removal of the first rib using video-assistance magnification and light, operating either directly or secondarily while visualizing the image on the television set. (The vast majority of cases have been performed using this latter technique.) Major indications for performing dorsal sympathectomy include (1) hyperhidrosis, (2) Raynaud's phenomenon, (3) Raynaud's disease, (4) causalgia, (5) reflex sympathetic dystrophy, and (6) vascular insufficiency of the upper extremity. Except for hyperhidrosis, all of the other indications require the usual diagnostic techniques, including cervical sympathetic blockade to assess whether the symptoms are relieved by temporary blockade of the sympathetic ganglia. In 326 patients, sympathectomy, performed either alone or in conjunction with first-rib removal for relief of the thoracic outlet syndrome, has been successful. In only 6 patients has sympathetic activity recurred in less than 6 months. Initially all of them were treated conservatively. Three of the 6 required a repeat sympathectomy. Postsympathectomy neuralgia occurred in only 2 of more than 326 patients. Both cases were managed successfully in a conservative fashion. Among the patients in whom a Horner's syndrome was not deliberately induced, the syndrome developed in 2. In both, the syndrome resolved spontaneously within several months.

Dorsal sympathectomy and management of thoracic outlet syndrome with VATS

Dorsal sympathectomy and the management of the thoracic outlet syndrome have been considerably improved with the use of video assistance because it affords both magnification and an improved light system. Two techniques of video assistance were employed in the group of patients described here. One involved the sympathectomy done through three ports using standard video-assisted thoracic surgical methods. The second technique involved a transaxillary incision with removal of the first rib using video-assistance magnification and light, operating either directly or secondarily while visualizing the image on the television set. (The vast majority of cases have been performed using this latter technique.) Major indications for performing dorsal sympathectomy include (1) hyperhidrosis, (2) Raynaud's phenomenon, (3) Raynaud's disease, (4) causalgia, (5) reflex sympathetic dystrophy, and (6) vascular insufficiency of the upper extremity. Except for hyperhidrosis, all of the other indications require the usual diagnostic techniques, including cervical sympathetic blockade to assess whether the symptoms are relieved by temporary blockade of the sympathetic ganglia. In 326 patients, sympathectomy, performed either alone or in conjunction with first-rib removal for relief of the thoracic outlet syndrome, has been successful. In only 6 patients has sympathetic activity recurred in less than 6 months. Initially all of them were treated conservatively. Three of the 6 required a repeat sympathectomy. Postsympathectomy neuralgia occurred in only 2 of more than 326 patients. Both cases were managed successfully in a conservative fashion. Among the patients in whom a Horner's syndrome was not deliberately induced, the syndrome developed in 2. In both, the syndrome resolved spontaneously within several months.

CERVICAL SYMPATHETIC BLOCKADE IN THE MANAGEMENT OF ACUTE STROKE

Medical Journal of AustraliaVolume 1, Issue 13 p. 566-566 Correspondence CERVICAL SYMPATHETIC BLOCKADE IN THE MANAGEMENT OF ACUTE STROKE First published: 01 March 1968 https://doi.org/10.5694/j.1326-5377.1968.tb28693.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue13March 1968Pages 566-566 RelatedInformation

CERVICAL SYMPATHETIC BLOCKADE IN THE MANAGEMENT OF ACUTE STROKE

Medical Journal of AustraliaVolume 1, Issue 8 p. 322-322 Correspondence CERVICAL SYMPATHETIC BLOCKADE IN THE MANAGEMENT OF ACUTE STROKE First published: 01 February 1968 https://doi.org/10.5694/j.1326-5377.1968.tb28516.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue8February 1968Pages 322-322 RelatedInformation