Effect Of Stellate Ganglion Block Research Articles

Effect of Stellate Ganglion Block on Dysphagia and Cognitive Impairment in Cerebral Small Vessel Disease: A Randomized Controlled Study.

Cerebral small vessel disease (CSVD) can potentially and frequently lead to dysphagia and cognitive impairment. Stellate ganglion block (SGB) can alleviate the symptoms by regulating neural pathways and improving cerebral blood circulation. This study aimed to explore the clinical effect of SGB on airway protection, dysphagia, cognitive impairment, and activities of daily living (ADL) in CSVD patients. This was a randomized controlled study conducted from February 2021 to May 2023, including 84 CSVD patients with dysphagia and cognitive impairment. The participants were randomly divided into the SGB group (n = 42) and the untreated group (n = 42). All received standard-of-care rehabilitation for 20 days. The SGB group received SGB once a day additionally. Assessments were conducted on Day 1 and Day 20, respectively. The Penetration-Aspiration Scale (PAS) was primary outcome. Modified Barium Swallow Impairment (MBSImp), Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI) and adverse events were secondary outcomes. This study was registered at ClinicalTrials.gov, Identifier: NCT06176404. There were two dropout cases in the untreated group. Time effect with statistical significance was observed in all assessments (p < .05). Group effect with statistical significance was observed in the PAS (z = -17.283, p < .001), MBSImp-Oral (z = -3.382, p = .001), MBSImp-Pharyngeal (z = -2.639, p = .008), MMSE (F = 7.450, p = .008), and MBI (F = 6.408, p = .013). During the treatment, there were no severe adverse events. SGB can significantly and safely improve airway protection, dysphagia, cognitive function, and ADL in CSVD patients with dysphagia and cognitive impairment who received standard-of-care rehabilitation.

Clinical effect of perioperative stellate ganglion block on mechanical ventilation and respiratory function of elderly patients with septic shock.

Here we investigated the effect of a stellate ganglion block on the perioperative mechanical ventilation and postoperative recovery of respiratory function of elderly patients with infectious shock. Thirty-six elderly patients with septic shock who underwent emergency general anesthesia at our hospital were randomly divided into treatment (T) and control (C) groups (n = 18 each). Group T received a preoperative stellate ganglion block, whereas group C received normal saline. Procalcitonin and C-reactive protein levels were compared preoperatively and at 1 and 7 days postoperative. Mean arterial pressure, oxygen saturation, and mean pulmonary artery pressure were measured preoperative and postoperative as well as at 1 and 7 days later. A blood gas analysis was performed preoperatively, at the end of the operation, during extubation, and at 1 and 7 days postoperative. Intubation under general anesthesia, the completion of anesthesia, and spontaneous respiratory recovery involve pulmonary dynamic compliance, plateau pressure, and mechanical ventilation. General condition did not differ significantly between groups (P > .05). However, mean arterial pressure at the end of surgery and at 1 and 7 days postoperative were significantly higher in group T versus C (P < .05). Furthermore, mean oxygen saturation at the end of surgery and at 1 and 7 days postoperative was significantly lower in group T versus C (P < .05), while procalcitonin and C-reactive protein levels were significantly lower at 1 and 7 days postoperative. Group T had significantly better arterial partial pressure of carbon dioxide, partial pressure of oxygen, and partial pressure of oxygen/fraction of inspired oxygen than group C at the end of surgery, during extubation, and at 1 and 7 days postoperative (P < .05). Group T exhibited superior inflammatory responses and respiratory function. Stellate ganglion block in elderly patients with septic shock reduces inflammation, improves mechanical ventilation perioperatively, and promotes postoperative recovery and respiratory function.

Effects of stellate ganglion block on the perioperative hemodynamics for coronary artery bypass grafting surgery

ABSTRACT Background Stellate ganglion block (SGB) is a successful technique that can potentially maintain hemodynamics and terminate fatal arrhythmia. We aimed to study the efficacy of SGB on hemodynamic changes after on pump coronary artery bypass grafting (CABG) surgery. Methods Forty patients who underwent CABG surgery at the Cardiac Surgical Academy Ain Shams University Hospital were randomly allocated to receive SGB or placebo between June 2020 and February 2021. After fulfilling the inclusion criteria, patients were classified as American Society of Anesthesiologists III and IV. Patients were randomly assigned to one of two groups utilizing a computer-generated block number in a sealed envelope. Group S (20 patients) received SGB, and Group C (20 patients) included matched controls who received a placebo solution in the SGB. Primary outcome was perioperative changes in heart rate and systolic and diastolic blood pressures. Secondary outcomes included the incidence of atrial and ventricular fibrillation, and myocardial ischemia in addition to the times from ICU admission to extubation, ICU stay, and hospital stay. Results A statistically substantial increase in systolic and diastolic blood pressure as well as increased incidence of AF and VF was found in the control group compared to the SGB group with p values <0.001, <0.001, 0.037, and 0.028, respectively. Conclusion SGB can reduce the hemodynamic responses to surgery and anesthesia, intraoperative tachyarrhythmias, and ICU and hospital stays.

Stellate ganglion block ameliorated central post-stroke pain with comorbid anxiety and depression through inhibiting HIF-1α/NLRP3 signaling following thalamic hemorrhagic stroke

BackgroundCentral post-stroke pain (CPSP) is an intractable and disabling central neuropathic pain that severely affects patients’ lives, well-being, and socialization abilities. However, CPSP has been poorly studied mechanistically and its treatment remains challenging. Here, we used a rat model of CPSP induced by thalamic hemorrhage to investigate its underlying mechanisms and the effect of stellate ganglion block (SGB) on CPSP and emotional comorbidities.MethodsThalamic hemorrhage was produced by injecting collagenase IV into the ventral-posterolateral nucleus (VPL) of the right thalamus. The up-and-down method with von Frey hairs was used to measure the mechanical allodynia. Behavioral tests were carried out to examine depressive and anxiety-like behaviors including the open field test (OFT), elevated plus maze test (EPMT), novelty-suppressed feeding test (NSFT), and forced swim test (FST). The peri-thalamic lesion tissues were collected for immunofluorescence, western blotting, and enzyme-linked immunosorbent assay (ELISA). Genetic knockdown of thalamic hypoxia-inducible factor-1α (HIF-1α) and NOD-like receptor thermal protein domain associated protein 3 (NLRP3) with microinjection of HIF-1α siRNA and NLRP3 siRNA into the VPL of thalamus were performed 3 days before collagenase injection into the same regions. Microinjection of lificiguat (YC-1) and MCC950 into the VPL of thalamus were administrated 30 min before the collagenase injection in order to inhibited HIF-1α and NLRP3 pharmacologically. Repetitive right SGB was performed daily for 5 days and laser speckle contrast imaging (LSCI) was conducted to examine cerebral blood flow.ResultsThalamic hemorrhage caused persistent mechanical allodynia and anxiety- and depression-like behaviors. Accompanying the persistent mechanical allodynia, the expression of HIF-1α and NLRP3, as well as the activities of microglia and astrocytes in the peri-thalamic lesion sites, were significantly increased. Genetic knockdown of thalamic HIF-1α and NLRP3 significantly attenuated mechanical allodynia and anxiety- and depression-like behaviors following thalamic hemorrhage. Further studies revealed that intra-thalamic injection of YC-1, or MCC950 significantly suppressed the activation of microglia and astrocytes, the release of pro-inflammatory cytokines, the upregulation of malondialdehyde (MDA), and the downregulation of superoxide dismutase (SOD), as well as mechanical allodynia and anxiety- and depression-like behaviors following thalamic hemorrhage. In addition, repetitive ipsilateral SGB significantly restored the upregulated HIF-1α/NLRP3 signaling and the hyperactivated microglia and astrocytes following thalamic hemorrhage. The enhanced expression of pro-inflammatory cytokines and the oxidative stress in the peri-thalamic lesion sites were also reversed by SGB. Moreover, LSCI showed that repetitive SGB significantly increased cerebral blood flow following thalamic hemorrhage. Most strikingly, SGB not only prevented, but also reversed the development of mechanical allodynia and anxiety- and depression-like behaviors induced by thalamic hemorrhage. However, pharmacological activation of thalamic HIF-1α and NLRP3 with specific agonists significantly eliminated the therapeutic effects of SGB on mechanical allodynia and anxiety- and depression-like behaviors following thalamic hemorrhage.ConclusionThis study demonstrated for the first time that SGB could improve CPSP with comorbid anxiety and depression by increasing cerebral blood flow and inhibiting HIF-1α/NLRP3 inflammatory signaling.

Retracted: Effect of Stellate Ganglion Block Combined with Lidocaine at Different Concentrations for Preemptive Analgesia on Postoperative Pain Relief and Adverse Reactions of Patients Undergoing Laparoscopic Cholecystectomy.

[This retracts the article DOI: 10.1155/2022/6027093.].

Effect of Stellate Ganglion Block in Patients with Ventricular Electrical Storm: A Case Report

If cardiac sympathetic activity increases after myocardial injury, a ventricular electrical storm (VES) may occur. The stellate ganglion block is a minimally invasive technique performed to control VES through temporary sympathetic cessation. This case was treated after 3 stellate ganglion blocks in VES developed after non-ST elevation myocardial infarction. This patient underwent prophylactic stellate ganglion block prior to radical nephrectomy for a renal mass found during hospitalization, and the operation was safely completed. Stellate ganglion block is expected to be a safe treatment option for patients with unstable VES.

Exploration on Effect of Stellate Ganglion Block on Vascular Endothelial Function in Male Patients with Sexual Dysfunction

Exploration on Effect of Stellate Ganglion Block on Vascular Endothelial Function in Male Patients with Sexual Dysfunction

Effect of Stellate Ganglion Block Combined with Lidocaine at Different Concentrations for Preemptive Analgesia on Postoperative Pain Relief and Adverse Reactions of Patients Undergoing Laparoscopic Cholecystectomy

Objective To explore the effect of stellate ganglion block (SGB) combined with lidocaine at different concentrations for preemptive analgesia on postoperative pain relief and adverse reactions of patients undergoing laparoscopic cholecystectomy (LC). Methods Ninety patients undergoing LC in our hospital from June 2019 to June 2020 were selected as the subjects and were randomly divided into group A (30 cases), group B (30 cases), and group C (30 cases), all patients received SGB, and 10 mL of lidocaine at concentrations of 0.25%, 0.5%, and 0.75% was, respectively, administered to patients in groups A, B, and C, so as to compare the analgesic effect, adverse reactions, and clinical indicators among the three groups. Results At T1 and T2, group C obtained obviously lower NRS scores than groups A and B (P < 0.001); compared with groups A and B, group A had obviously higher onset time (P < 0.001) and significantly lower duration (P < 0.001); no obvious differences in the hemodynamic indexes among the groups were observed (P > 0.05); group C obtained obviously higher BCS score than groups A and B; and the total incidence rate of adverse reactions was obviously higher in group C than in groups A and B (P < 0.05). Conclusion Performing SGB combined with 0.5% lidocaine to patients undergoing LC achieves the optimal analgesic effect; such anesthesia plan can effectively stabilize patients' hemodynamics, present higher safety, and promote the regulation of the body internal environment. Further research will be conducive to establishing a better anesthesia plan for such patients.

Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound.

ObjectiveThis study aimed to investigate the effects of stellate ganglion block (SGB) through different approaches under guidance of ultrasound.MethodsA total of 130 patients undergoing SGB in our hospital between February 2019 and February 2020 were enrolled as the research subjects. According to the random number table method, these subjects were divided into two groups: a modified 6th cervical vertebra (C6) group (n = 65) and a 7th cervical vertebra (C7) group (n = 65). Under the guidance of ultrasound, the subjects in the modified C6 group were punctured at the level of the C6 transverse process, and the subjects in the C7 group were punctured at the level of the C7 transverse process. The operation duration, number of puncture angle adjustments, block effects, and adverse reactions for SGB were compared between the two groups.ResultsThe modified C6 group showed shorter SGB operation duration and a lower number of puncture angle adjustments than the C7 group, and the differences were statistically significant (P < 0.05). Horner Syndrome occurred in both groups after SGB. The incidence of adverse reactions in the modified C6 group was 4.62%, comprising 1 case of hoarseness and 2 cases of slowed pulse, while that in the C7 group was 6.15%, with 1 case of hoarseness and 3 cases of slowed pulse; the difference between the two groups was not statistically significant (P > 0.05).ConclusionThe operation duration for modified SGB guided by ultrasound puncturing at the C6 transverse process is shorter and requires fewer puncture angle adjustments than puncturing at the C7 transverse process; however, there is no significant difference between the incidence of adverse reactions or the blocking effects of the two methods.

Stellate ganglion block reduces inflammation and improves neurological function in diabetic rats during ischemic stroke.

Diabetes mellitus is an independent risk factor for ischemic stroke. Both diabetes mellitus and stroke are linked to systemic inflammation that aggravates patient outcomes. Stellate ganglion block can effectively regulate the inflammatory response. Therefore, it is hypothesized that stellate ganglion block could be a potential therapy for ischemic stroke in diabetic subjects. In this study, we induced diabetes mellitus in rats by feeding them a high-fat diet for 4 successive weeks. The left middle cerebral artery was occluded to establish models of ischemic stroke in diabetic rats. Subsequently, we performed left stellate ganglion block with 1% lidocaine using the percutaneous posterior approach 15 minutes before reperfusion and again 20 and 44 hours after reperfusion. Our results showed that stellate ganglion block did not decrease the blood glucose level in diabetic rats with diabetes mellitus but did reduce the cerebral infarct volume and the cerebral water content. It also improved the recovery of neurological function, increased 28-day survival rate, inhibited Toll like receptor 4/nuclear factor kappa B signaling pathway and reduced inflammatory response in the plasma of rats. However, injection of Toll like receptor 4 agonist lipopolysaccharide 5 minutes before stellate ganglion block inhibited the effect of stellate ganglion block, whereas injection of Toll like receptor 4 inhibitor TAK242 had no such effect. We also found that stellate ganglion block performed at night had no positive effect on diabetic ischemic stroke. These findings suggest that stellate ganglion block is a potential therapy for diabetic ischemic stroke and that it may be mediated through the Toll like receptor 4/nuclear factor kappa B signaling pathway. We also found that the therapeutic effect of stellate ganglion block is affected by circadian rhythm.

Continuous SGB Inhibits Occurrence and Maintenance of Mechanical Hyperalgesia via Reducing Inflammatory Cytokines in Striatum and PAG of PD Nociception Rat Models.

To investigate the effect of stellate ganglion block (SGB) on nociception in Parkinson's disease (PD) rat models, and to clarify the associated mechanism. To generate PD nociception rat model 6-hydroxydopamine (6-OHDA) injection method was used. Paw withdrawal threshold (PWT) and paw retraction latency (PWL) was used to reflect mechanical stimulation and thermal stimulation, respectively, at pre-modeling and 1, 2, 3, 4 weeks post modeling. The preventive and therapeutic effects of SGB treatment on nociception were observed in Naive, Vehicle, and 6-OHDA group (model). Levels of IL-1β, IL-6, and TNF-α in striatum and periaqueductal gray (PAG) were detected with ELISA. 6-OHDA injection induced obvious reduction of bilateral PWT from 2 to 4 weeks post modeling, suggesting that PD nociception rat model was successfully established. Continuous SGB prevention inhibited mechanical hyperalgesia at 2, 3 and 4 weeks post modeling, and significantly reversed mechanical hyperalgesia at 3 and 4 weeks post modeling, compared with those of Saline group (p < 0.05). These results suggest that continuous SGB could effectively prevent and alleviate pain of PD rats. SGB treatment remarkably suppressed levels of inflammatory factors (IL-1 β, IL-6, and TNF-α) in striatum and PAG of PD rats compared with those of rats in Vehicle group (p < 0.05). Continuous SGB effectively inhibited and reversed mechanical hyperalgesia of PD nociception rats through inhibiting inflammatory response in striatum and PAG.

Malignant arrythmic storm, stellate ganglion and diabetes mellitus

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Malignant arrhythmic storm (MAS) increases mortality more than three-fold according to current data. In the acute setting, besides resolving reversible causes, antiarrhythmics are the mainstay of treatment. The role of suppressing the local sympathetic nervous system activity, using stellate ganglion block (SGB) for example, is still being investigated. Purpose To show short-term efficacy of SGB in suppressing the ventricular arrhythmia recurrence in MAS. To identify subgroups of patients with better clinical response after SGB. Methods All consecutive patients with MAS, with standard treatment failure and ventricular arrhythmia recurrence, treated with ultrasound guided SGB, instilating 7ml of 0,5% Bupivacain. 58 MAS treated with SGB durin 2017 – 2020. There were 49 men (84,5%), average age 68,7 +/- 11,4, with average left ventricular EF 28,9 +/- 8,43%. There were 17 diabetics (29,3%). Results When we compare the numbers of defibrillations for sustained ventricular tachycardia 48 hours before and 48 hours after SGB, being the primary therapeutic endpoint in MAS, we see a 96,7% reduction (p &amp;lt; 0,001). When we evaluate ventricular arrhythmias treated with both antitachycardia pacing and shocks, then we see 90% reduction (p &amp;lt; 0,001). The effect of SGB in ventricular arrhythmia suppression was statistically significant during the entire follow-up of 8 days. When we analyzed the cohort, looking for groups showing better response after SGB in terms of ventricular arrhythmia reduction, the only group showing statistical significance in this regard are patients with diabetes mellitus. Conclusions In our cohort, stellate ganglion block is exceptionally effective in the treatment algorithm of malignant arrhythmic storm. SGB shows significantly higher efficacy in the subgroup of patients with diabetes mellitus. Abstract Figure. VA before and after BSG

Effects of stellate ganglion block on early brain injury in patients with subarachnoid hemorrhage: a randomised control trial

BackgroundSubarachnoid hemorrhage (SAH) is a common neurosurgical emergency, and early brain injury (EBI) plays an important role in acute brain injury of SAH. Our objective is to investigate the effect of stellate ganglion block (SGB) on the clinical prognosis of patients with SAH (registration number ChiCTR2000030910).MethodsA randomized controlled trial was conducted with 102 participants. Patients with SAH were assigned to the SGB or nSGB group. Patients in the SGB group received SGB four times (once every other day starting on the day of the surgery). In contrast, patients in the nSGB group only received standard care. Data were collected on the day before surgery (T0) and on the 1st (T1), 3rd (T2) and 7th day (T3) after surgery. The primary outcomes included EBI markers (including IL-1β, IL-6, TNF-α, ET-1, NPY, NSE and S100β), the mean cerebral blood flow velocity of the middle cerebral artery (Vm-MCA) and the basilar artery (Vm-BA). All cases were followed up for 6 months after surgery.ResultsThe levels of the EBI markers in both groups were higher at T1–T3 than at T0 (P<0.05), and the Vm-MCA and Vm-BA were also increased at the same times. However, the levels of the EBI markers were lower in the SGB group than in the nSGB group (P<0.05), and the increases of Vm-MCA and Vm-BA were also lower (P<0.05). The prognosis score and neurological deficit were better in the SGB group than in the nSGB group (P<0.05).ConclusionsSGB can improve the prognosis of SAH patients by inhibiting the inflammatory response during EBI and by reducing endothelial dysfunction and relieving CVS.Trial registrationClinical trial number: ChiCTR2000030910; Registry URL: Chinese Clinical Trial Registry; Principal investigator's name: Ying Nie; Date of Trial registration: March, 2020 (retrospectively registered).

The Therapeutic Effects of Stellate Ganglion Block on Dental Diseases

The Therapeutic Effects of Stellate Ganglion Block on Dental Diseases

Effect of stellate ganglion block on postoperative recovery of gastrointestinal function in patients undergoing surgery with general anaesthesia: a meta-analysis

BackgroundThe return of gastrointestinal function is an important sign of postoperative recovery in patients undergoing surgery with general anaesthesia. We aimed to summarize the effects of stellate ganglion block on the recovery of gastrointestinal function as a means of exploring methods through which anaesthesiologists can contribute to postoperative patient recovery.MethodsWe performed a quantitative systematic review of randomized controlled trials published between January 1, 1988, and November 11, 2019, in PubMed, the Cochrane Library, China National Knowledge Infrastructure, Chinese VIP Information, and the Wanfang and SinoMed databases. Study quality was assessed by using the GRADE criteria and bias of included studies were assessed using the revised Cochrane risk-of-bias tool for randomized trials. The time to peristaltic sound resumption, flatus, postoperative eating and the incidence of abdominal bloating in the stellate ganglion block and control groups were compared. The control group consisted of either a stellate ganglion block with normal saline or no treatment. Meta-analysis was performed using Review Manager software.ResultsAfter searching for relevant articles, 281 studies were identified, and five articles with data on 274 patients were eligible. Regarding postoperative flatus time, stellate ganglion block resulted in a mean reduction of 15 h (P = 0.02); then a sensitivity analysis was performed, and the standard mean difference decreased to 6 h (P = 0.007). For gastrointestinal surgery, the mean reduction was 23.92 h (P = 0.0002). As for the evaluation of the recovery of peristaltic sounds, stellate ganglion block promoted the recovery of regular peristaltic bowel sounds an average of 14.67 h earlier than in the control (P = 0.0008). When it comes to nutrients, stellate ganglion block shortened the total parenteral nutrition time by more than 50 h in patients who had undergone gastrointestinal surgery (P<0.00001). Finally, stellate ganglion block prevented the occurrence of postoperative abdominal bloating (P = 0.001).) No complications related to stellate ganglion block were reported.ConclusionStellate ganglion block may promote postoperative gastrointestinal recovery in patients undergoing various surgeries under general anaesthesia. However, additional trials investigating the use of stellate ganglion block are necessary to confirm our finding.Trial registrationThis meta-analysis has been registered at the International Prospective Register of Systematic Reviews (registration number CRD42020157602).

Effects of Stellate Ganglion Block on Healing of Fractures Induced in Rats.

Objective Sympathetic blocks are used as an adjunct for pain management in the treatment of orthopedic and traumatic conditions. Stellate ganglion (ganglion stellatum) provides sympathetic innervation of the head, neck and cervicothoracic regions, and upper extremities. No study was found in the literature investigating the effects of stellate ganglion block performed in the upper extremity, on blood supply to bone, density, vascularization, and bone metabolism. Therefore, the objective of this study was to investigate the effects of stellate ganglion block on healing of closed forearm fractures that were induced in rats. Material and Methods. A total of 42 Wistar albino rats weighing between 398 and 510 g were used in this study. The rats were randomly divided into 2 groups with one group treated with stellate ganglion and the other included as the control group. In each 2 groups, a closed forearm fracture was created, confirmed with X-ray, and then stabilized by splint application. The forearm bones were examined with X-ray views on the same day and were then decalcified. Results When histological findings of the fracture region were examined, predominantly cartilage and less woven bone were found in 7 rats, equally distributed cartilage and immature bone in 14 rats, and predominantly imitation bone and less cartilage formation in 21 rats. In the control group, the agreement between the 1st and 2nd orthopedists for the radiological evaluation of bone formation was moderate. Conclusion The group administered stellate ganglion block showed a more significant fracture healing.

Effects of stellate ganglion block on postoperative trigeminal neuropathy after dental surgery: a propensity score matching analysis

This study aimed to evaluate the effects of stellate ganglion block (SGB) on postoperative trigeminal neuropathy (TNP) after dental surgery. This was a retrospective study based on the medical records of all patients with postoperative TNP at Kyushu Dental University Hospital from 2014 to 2019. Patients were divided into the SGB group (received SGB) and non-SGB group (did not receive SGB). We evaluated the severity of TNP at 3 months after surgery and the incidence rate of abnormal sensations. Abnormal sensations were counted using patients’ reports of uncomfortable symptoms during the treatment, including dysaesthesia, allodynia, and hyperalgesia. A propensity score (PS) matching analysis was performed to evaluate these data. After PS matching, amongst others, the force equivalent values of the Semmes–Weinstein test at 3-months post-treatment were significantly lower in the SGB group than in the non-SGB group (2.00 ± 0.44 vs 2.30 ± 0.48; p < 0.05). In addition, after PS matching, the incidence rate of abnormal sensations during the treatment was significantly lower in the SGB group than in the non-SGB group (10 cases [4.7%] vs 22 cases [10.3%]; p < 0.05). Collectively, the findings support that SGB may improve the recovery from postoperative TNP and reduce the incidence rate of abnormal sensations after dental surgery.

Observation on the Effect of Stellate Ganglion Block Combined with Routine Medication on Male Sexual Dysfunction

Observation on the Effect of Stellate Ganglion Block Combined with Routine Medication on Male Sexual Dysfunction

Effect of stellate ganglion block versus intraluminal application of verapamil-nitroglycerine solution on internal mammary artery graft blood flow rate in patients undergoing on-pump coronary artery bypass grafting

Background Left internal mammary artery (IMA) graft is the most promising arterial conduit for coronary artery bypass grafting. Stellate ganglion block (SGB) induces sympathetic blockade and is used to prevent or control spasm of the internal mammary artery. The purpose of this study was to investigate the effect of left SGB on left IMA blood flow rate. Patients and methods A total of 170 patients aged between 65 and 70 years, with American Association of Anesthesiologists physical status II and III, and scheduled for elective coronary artery bypass grafting, were randomly allocated to either a SGB group or a verapamil-nitroglycerine group. In the SGB group, the patients received SGB using 8 ml of bupivacaine 0.25%. In the verapamil-nitroglycerine group, the patients received intraluminal injection of the harvested IMA graft with a solution, containing verapamil 5 mg, nitroglycerine 2.5 mg, heparin 500 U, 8.4% NAHCO3 0.2 ml, and ringer solution 40 ml, throughout its whole length using a small syringe, and with a low dose of intravenous nicardipine infusion started after harvesting (5 mg nicardipine in 100 ml saline at a rate of 0.5 mg or 10 ml/h). IMA blood flow rate (primary outcome), abnormal ECG changes, ICU length of stay, intra-aortic balloon usage, pre–postoperative pulse rate and blood pressure, incidence of atrial fibrillation, radio-femoral arterial pressure difference, pre–postoperative ejection fraction, need for re-exploration, and mortality rate were observed. Results This prospective study showed a significant increase of IMA blood flow rate (P Conclusion The results of this study showed that SGB prevents IMA spasm, increases its blood flow rate, and decreases incidence of atrial fibrillations compared with intraluminal injection of verapamil and nitroglycerine combined with intravenous nicardipine.

Effect of Stellate Ganglion Block on Intraoperative Propofol and Fentanyl Consumption in Patients with Complex Regional Pain Syndrome Undergoing Surgical Repair of Brachial Plexus Injury: A Randomized, Double-blind, Placebo-controlled Trial.

Stellate ganglion block (SGB) is commonly performed to treat chronic painful conditions, such as complex regional pain syndrome (CRPS) and postherpetic neuralgia. However, whether it is effective in reducing anesthesia and analgesia requirement during surgery (acute pain) is not known. Sixty American Society of Anesthesiologists (ASA) physical status I and II patients with CRPS type II undergoing surgery for repair of brachial plexus injury were randomized (1:1) to receive SGB with either 10 mL of 0.5% bupivacaine (Group B) or a matching placebo (Group S) before induction of anesthesia. There was a significant reduction in the requirement of total intraoperative propofol (1659.7 ± 787.5 vs. 2500.7 ± 740.9 mg, P = 0.0003) and fentanyl (190.0 ± 82.5 vs. 327.3 ± 139.3, P = 0.0001) in Group B compared with Group S. Similarly, in Group B, the time to first analgesic was much longer (328 ± 219 vs. 64 ± 116 min, P = 0.000) and postoperative fentanyl requirement for 24 h was lesser compared to Group S (0.6 ± 1.1 vs. 2.1 ± 1.3 μg/kg, P = 0.000). SGB is effective in reducing the requirement of intraoperative propofol and fentanyl as well as decreasing opioid requirement in the postoperative period in patients with CRPS type II undergoing surgery.