Effect Of Stellate Ganglion Block Research Articles

Effects on hemodynamic variables and echocardiographic parameters after a stellate ganglion block in 15 healthy volunteers.

The sympathetic nervous system has an important role in generating pain. Various pathomechanisms are involved that respond well to the application of local anesthetics (LA), for example to the stellate ganglion block (SGB). We wanted to know more about the effects of SGB on cardiovascular parameters. We included 15 healthy volunteers; another 15 healthy volunteers as a control group (sham injection of LA). In order to produce a more precise SGB, we employed only a small volume of LA (3mL), a LA with a lower permeability (procaine 1%), and a modified injection technique. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and echocardiographic parameters were recorded before and after SGB. We also investigated whether there are side differences (left and right SBG). At baseline all parameters were within the normal range. After performing right and left SGB DBP significantly increased (on the right side from 68.73±8.61 to 73.53±11.10, p=0.015; on the left side from 70.66±13.01 to 77.93±10.40, p=0.003). In the control group no increase in DBP was observed. No side-specific differences were found, except a significant reduction in the maximum velocity of myocardial contraction during the systole with left-sided SGB. Even with our methods we could not prevent the simultaneous occurrence of a partial parasympatholytic effect. For this reason, the SGB has only minor hemodynamic effects, which is desirable as it enhances the safety of the SGB.

Therapeutic potential of stellate ganglion block in orofacial pain: a mini review.

Orofacial pain is a common complaint of patients that causes distress and compromises the quality of life. It has many etiologies including trauma, interventional procedures, nerve injury, varicella-zoster (shingles), tumor, and vascular and idiopathic factors. It has been demonstrated that the sympathetic nervous system is usually involved in various orofacial pain disorders such as postherpetic neuralgia, complex regional pain syndromes, and atypical facial pain. The stellate sympathetic ganglion innervates the head, neck, and upper extremity. In this review article, the effect of stellate ganglion block and its mechanism of action in orofacial pain disorders are discussed.

Effect of Stellate Ganglion Block on Early Postoperative Insomnia of Lung Cancer

Effect of Stellate Ganglion Block on Early Postoperative Insomnia of Lung Cancer

Effect of Stellate Ganglion Block on the Cerebral Cortex: A Functional Magnetic Resonance Imaging Study

The objective of this study is to investigate the neural activities in the human brain after stellate ganglion block (SGB) treatment using functional magnetic resonance imaging (fMRI). Thirteen healthy female volunteers from the local community participated in the study. An echo planar imaging sequence for fMRI has used to examine the effect on the cerebral cortex before and after SGB stimulation at 1.5T MRI. We used 6 mL of 1 % mepivacaine hydrochloride as a local anesthetic. Two control groups with and without a saline injection were also included. FMRI data were processed using statistical parametric mapping. The blood-oxygen-level-dependent fMRI signal intensities increased in contralateral anterior cingulate cortex, hypothalamus, ventral putamen, and parahippocampal gyrus after SGB stimulation, while the signal intensities had decreased in contralateral thalamus and dorsal putamen, and ipsilateral caudate nucleus. In the saline control group, the signal intensities in ipsilateral posterior putamen and superior temporal gyrus and both insular cortices have increased significantly. The present study could show the changes by SGB in the several important brain areas associated with sympathetic nervous system. The non-invasive and repeatable imaging technique of fMRI could provide some useful information for better understanding of the neural mechanisms involved in SGB treatments.

1909 Effects of stellate ganglion block on breast cancer-related lymphedema: Comparison of various injectates

1909 Effects of stellate ganglion block on breast cancer-related lymphedema: Comparison of various injectates

The Therapeutic Effect of Stellate Ganglion Block on Facial Nerve Palsy in Patients with Type 2 Diabetes Mellitus

Background/Aims: The conventional systemic corticosteroid treatment for acute peripheral facial nerve palsy in patients with type 2 diabetes mellitus can induce hyperglycemia, and an alternative local therapy may be necessary. Our purpose in this study is to evaluate therapeutic effects of stellate ganglion block (SGB) on facial nerve palsy in patients with type 2 diabetes mellitus. Methods: A total of 361 cases of acute peripheral, chronic peripheral, acute central and chronic central facial nerve palsy treated with SGB or conventional therapy were included in this retrospective study. The facial nerve function score (Sunnybrook Facial Grading System) obtained at before and after treatment in non-SGB and SGB groups was used to assess the outcome. Furthermore, the blood glucose level in acute peripheral facial nerve palsy was measured. Results: The facial nerve function score in the SGB group was higher than that in the non-SGB group after treatment in peripheral facial nerve palsy, while the blood glucose level in the non-SGB group increased and was higher than that in the SGB group during the treatment in acute peripheral facial nerve palsy. Conclusions: Our findings suggest that SGB has better therapeutic effect than conventional treatment on acute and chronic peripheral facial nerve palsy in patients with type 2 diabetes mellitus.

Effect of stellate ganglion block on acute lung injury in septic rats

Objective To evaluate the effect of stellate ganglion block (SGB) on acute lung injury in septic rats. Methods Ninety male Sprague-Dawley rats, aged 12-15 weeks, weighing 300-350 g, were equally and randomly divided into 3 groups using a random number table: sham operation group (group S), sepsis group (group Sep) and SGB group.Cervical sympathetic trunk transaction was performed to induce right SGB in group SGB, and 30 min later sepsis was produced by cecum ligation and puncture (CLP) in CLP and SGB groups.At 5 min before CLP (T0) and 2, 6, 12 and 24 h after CLP (T1-4), 6 rats were selected in each group, and blood samples were taken from the abdominal aorta for determination of the levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and IL-10 in serum by enzyme-linked immunosorbent assay.The rats were sacrificed after each blood sampling, and lungs were removed for microscopic examination of the pathological changes of lungs which were scored and for determination of wet/dry lung weight ratio (W/D ratio), myelopemxidase (MPO) activity (by spectrophotometry) and nuclear factor kappa B (NF-κB) p65 expression (using Western blot). Results Compared with group S, the serum TNF-α, IL-6 and IL-10 concentrations, W/D ratio, pathological scores, and MPO activity were significantly increased, and the expression of NF-κB p65 was up-regulated at T1-4 in Sep and SGB groups.Compared with group Sep, the serum TNF-α and IL-6 concentrations, W/D ratio, pathological scores, and MPO activity were significantly decreased, and the serum IL-10 concentrations were increased, and the expression of NF-κB p65 was down-regulated at T1-4 in group SGB. Conclusion SGB can attenuate acute lung injury in septic rats. Key words: Stellate ganglion; Nerve block; Sepsis; Respiratory distress syndrome, adult

Effects of Stellate Ganglion Block on Sedation as Assessed by Bispectral Index in Normal Healthy Volunteers

Background: The sympathetic nervous system plays an important role in the arousal response. Recently, the stellate ganglion block (SGB) was found to effectively treat anxiety and night awakening in humans and decrease electroencephalogram (EEG) indices of arousal responses in rat. But, the role of the sympathetic block in human arousal responses has not yet been studied. Objective: We performed this prospective, double-blinded, controlled volunteer study to investigate the sedative effects and bispectral index (BIS) changes of SGB. Study Design: A randomized, double-blind trial. Setting: Single academic medical center. Methods: This study was approved by the Ethics Committee of Kyungpook National University Hospital (ref: KNUH_10-1081) and registered with CRiS (Clinical Research Information Service, http://cris.cdc.go.kr, ref: KCT0000036, 2010. 9.24). Twenty healthy volunteers were enrolled in this study. The volunteers were randomly assigned to one of 2 groups: the SGB group (n = 10) and the sham group (n =10). Volunteers in SGB group received SGB and volunteers in the sham group received a sham procedure. BIS value, heart rate, and blood pressure were measured before and 5, 10, 20, and 30 minutes after the procedure. Observer’s Assessment of Alertness/Sedation (OAA/S) scores were assessed before and 10 and 30 minutes after the intervention. Results: In the SGB group, BIS values and OAA/S scores significantly decreased after the intervention as compared to baseline (P < 0.05). The values were also significantly decreased in the SGB group when compared to the values in sham group after the intervention (P < 0.05). There was a significant change of mean blood pressure 10 to 30 minutes after SGB (P < 0.05). There were no differences in heart rate during study period between groups. Limitations: This study is limited by a relatively small sample size. Conclusions: This study showed that SGB has a sedative effect in normal healthy volunteers, as evidenced by decreased OAA/S scores and BIS values. Key words: Stellate ganglion, sympathetic block, sedation, bisepctral index, EEG, volunteers

Effects of stellate ganglion block on cardiovascular reaction and heart rate variability in elderly patients during anesthesia induction and endotracheal intubation

Study ObjectiveTo investigate the effects of stellate ganglion block (SGB) on cardiovascular response and heart rate (HR) variability in elderly patients during anesthesia induction and endotracheal intubation. DesignA randomized, double-blinded, and placebo-controlled study. SettingUniversity-affiliated teaching hospital. ParticipantsEighty elderly patients (American Society of Anesthesiologists grades I and II) receiving elective surgery during general anesthesia. InterventionsRight stellate ganglion injection (SGB) was performed in all patients using 10 mL of 1% lidocaine or normal saline. MeasurementsSystolic blood pressure (BP), diastolic BP, HR, and calculated rate pressure product. HR variability at the following time points: conscious status before induction (T0); immediately before intubation (T1); immediately after intubation (T2); and 1, 3, and 5 minutes postintubation (T3, T4, and T5). Main ResultsNo significant differences in BP and HR were observed between the 2 groups. Rate pressure product values significantly increased in the control group compared with baseline and SGB group values. Low-frequency power (LF) and LF/high-frequency power (HF) significantly increased, and HF and normalized units of HF significantly decreased in the control group compared with baseline values. LF, normalized units of LF, and LF/HF in the SGB group significantly decreased compared with those of the control group. ConclusionSGB protects the myocardium and effectively suppresses stress responses during anesthesia induction and tracheal intubation in elderly patients.

The effect of stellate ganglion block on intractable lymphedema after breast cancer surgery.

Lymphedema of the upper limb after breast cancer surgery is a disease that carries a life-long risk and is difficult to cure once it occurs despite the various treatments which have been developed. Two patients were referred from general surgery department for intractable lymphedema. They were treated with stellate ganglion blocks (SGBs), and the circumferences of the mid-point of their each upper and lower arms were measured on every visit to the pain clinic. A decrease of the circumference in each patient was observed starting after the second injection. A series of blocks were established to maintain a prolonged effect. Both patients were satisfied with less swelling and pain. This case demonstrates the benefits of an SGB for intractable upper limb lymphedema.

Effects of stellate ganglion block on the peri-operative vasomotor cytokine content and intrapulmonary shunt in patients with esophagus cancer.

To investigate the effects of stellate ganglion block (SGB) on the peri-operative vasomotor cytokine content and intrapulmonary shunt in patients with esophagus cancer who underwent thoracotomy. Forty patients undergoing elective resection of esophageal cancer patients who had I~II American Society of Anesthesiologist (ASA) were randomly divided into total intravenous anesthesia group (group N, n=20) and total intravenous anesthesia combined with SGB group (group S, n=20, 0.12 mL/kg 1% lidocaine was used for SGB 10 min before induction). Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary arterial pressure (MPAP) and continuous cardiac output (CCO) were continuously monitored. The blood from internal jugular vein was drawn respectively before induction (T0), and 30 min (T1), 60 min (T2) and 120 min (T3) after one-lung ventilation (OLV), and 30 min (T4) after two-lung ventilation. The contents of plasma endothelin (ET), nitric oxide (NO) and calcitonin gene-related peptide (CGRP) were detected with enzyme linked immunosorbent assay (ELISA). Meanwhile, arterial and mixed venous blood samples were collected for determination of blood gas and calculation of intrapulmonary shunt fraction (Qs/Qt). During OLV, ET contents were increased significantly in two groups (P<0.05), and no significant difference was presented (P>0.05). NO content in group S was obviously higher than in group N at T3 (P<0.05), whereas CGRP content in group N was markedly lower than in group S at each time point (P<0.05). Qs/Qt was significantly increased in both groups after OLV, but there was no statistical significant regarding the Qs/Qt at each time point between two groups. Total intravenous anesthesia combined with SGB is conducive to regulation of perioperative vasomotor cytokines in thoracotomy, and has little effect on intrapulmonary shunt at the time of OLV.

Protective effect of stellate ganglion block on delayed cerebral vasospasm in an experimental rat model of subarachnoid hemorrhage

Stellate ganglion block (SGB) is a blockade of sympathetic ganglia innervating the head and neck, and is known to function through vasodilation of the target region. However, the effectiveness of SGB in relieving cerebral vasospasm (CVS) through dilation of intracerebral vessels has not been evaluated. The aim of the present study is to investigate the therapeutic effects of SGB in a rat model of subarachnoid hemorrhage (SAH) complicated by delayed CVS, and explore the underlying mechanisms. The SAH model was established by double injection of autologous arterial blood into the cisterna magna. We simulated SGB by transection of the cervical sympathetic trunk (TCST), and measured changes in the diameter, perimeter and cross-sectional area of the basilar artery (BA) and middle cerebral artery (MCA) to evaluate its vasodilatory effect. To investigate the underlying mechanisms, we determined the expression level of vasoactive molecules endothelin-1 (ET-1) and calcitonin gene-related peptide (CGRP) in the plasma, and apoptotic modulators Bcl-2 and Bax in the hippocampus. We found a significant increase in the diameter, perimeter and cross-sectional area of the BA and right MCA in SAH rats subjected to TCST. Application of SGB significantly reduced the expression of ET-1 while increasing that of CGRP in SAH rats. We also found a significant increase in the expression of Bcl-2 and decrease in the expression of Bax in the hippocampus of SAH rats subjected to TCST, when compared to untreated SAH rats. The mechanism of action of SGB is likely mediated through alterations in the ratio of ET-1 and CGRP, and Bax and Bcl-2. These results suggest that SGB can alleviate the severity of delayed CVS by inducing dilation of intracerebral blood vessels, and promoting anti-apoptotic signaling. Our findings provide evidence supporting the use of SGB as an effective and well-tolerated approach to the treatment of CVS in various clinical settings.

Effects of stellate ganglion block on vasomotor symptoms

Uncontrolled intervention studies, including studies involving breast cancer survivors, have demonstrated improvements in vasomotor symptoms (VMS) after stellate ganglion blockade (SGB) with a local anesthetic. This study presents the first randomized sham-controlled trial of SGB for the treatment of VMS. Participants included 40 postmenopausal women, aged 30 to 70 years, with moderate to severe VMS. The study was a randomized sham-controlled trial comparing the effects of SGB versus sham injection on the frequencies of total and moderate to severe VMS, as measured by daily diaries. Image-guided SGB was performed with 5 mL of 0.5% bupivacaine. Sham injection of saline was performed in subcutaneous tissues in the neck. VMS were recorded at baseline and for 6 months thereafter. Objective VMS were recorded using ambulatory sternal skin conductance monitoring during a 24-hour period at baseline and on 3-month follow-up. There were no significant group differences in overall VMS frequency, but the frequency of moderate to very severe VMS was reduced more in the active group compared with the sham treatment group (event rate ratio, 0.50; 95% CI, 0.35-0.71; P < 0.001). The frequency of objective VMS was also reduced to a greater degree in the SGB group than in the sham group (event rate ratio, 0.71; 95% CI, 0.64-0.99; P < 0.05). There were no study-related serious adverse events. SGB may provide effective treatment of VMS in women who seek nonhormonal treatments because of safety concerns and personal preference. The finding that SGB significantly reduces objectively measured VMS provides further evidence of efficacy. A larger trial is warranted to confirm these findings.

Effects of stellate ganglion block on AMP-ativated protein kinase and astrocyte in hippocampal neurons in postoperative aged rats

To investigate the effects of stellate ganglion block on AMP-activated protein kinase and astrocyte in hippocampal neurons in postoperative aged rats. A total of 96 male Sprague-Dawley rats aged 18-20 months, weighing 450-550 g, were randomly divided into 4 groups (n = 24): Control group (Group I); Surgery group (Group II); Normal saline + surgery group (Group III); SGB+ surgery group (Group IV). SGB with 0.25% bupivacaine 0.15 ml and operation was conducted after 15 min in groups II, III and IV. The eight rats were randomly sacrificed in each group postoperative 1, 3, and 5 d. The escape latency and swimming distance were recorded by morris water maze. The expression of AMPKmRNA,AMPK and phosphorylated AMPK(p-AMPK) was measured by RT-PCR and Western blot. The expression of GFAP was measured by immunohistochemisty. Compared with I group, the escape latency and swimming distance were significantly prolonged and the expression of AMPK mRNA, AMPK and p-AMPK was up-regulated and the expression of GFAP in astrocyte was significatively increased in groups II, III and IV. Compared with II and III group, the escape latency and swimming distance were significantly shorten and the expression of AMPK mRNA, AMPK and p-AMPK was down-regulated and the expression of GFAP in astrocyte was significatively decreased in group IV. SGB can improve the postoperative cognitive function, and the mechanism may be associated with down-regulating the expression of AMPK and restraining the activation of the astrocyte.

The case for invasive placebo – is the devil in the detail?

The case for invasive placebo – is the devil in the detail?

Effect of stellate ganglion block on postoperative synaptic structure in hippocampal CA3 region in aged rats

Objective To evaluate the effect of stellate ganglion block (SGB) on postoperative synaptic structure in hippocampal CA3 region in aged rats.Methods Seventy-two male Sprague-Dawley rats,aged 20-22 months,weighing 550-650 g,were randomly divided into 3 groups (n =24 each) using a random number table:control group (group C),operation group (group O) and SGB + operation group (group SGB).Group SGB received right SGB with 0.25％ bupivacaine 0.15 ml.Groups O and SGB underwent 30 min of exploratory laparotomy starting from 15 min after the end of administration.Y-maze test was performed on 1 day after operation in 6 rats chosen from each group for assessment of cognitive function.The frequency of standard training and standard time were recorded.Six rats were chosen from each group on 1,3 and 7 days after operation and sacrificed and the hippocampal CA3 region was isolated for microscopic examination and for measurement of synaptic structure.Results Compared with group C,the standard time was significantly prolonged,and the frequency of standard training was increased in groups O and SGB,the width of synaptic cleft was increased,the thickness of post-synaptic density was decreased,the length of active zones was shortened,and the curvature of the synaptic interface was decreased on 1,3 and 7 days after operation in group O (P ＜ 0.05),and no significant changes were found in each synaptic structure parameter in group SGB (P ＞ 0.05).Compared with group O,the standard time was significantly shortened,the frequency of standard training was decreased,the width of synaptic cleft was decreased,the thickness of the post-synaptic density was increased,the length of active zones was prolonged,and the curvature of the synaptic interface was increased on 1,3 and 7 days after operation in group SGB (P ＜ 0.05).Conclusion The mechanism by which SGB improves the postoperative cognitive dysfunction in aged rats may be related to inhibition of changes of synaptic structure in hippocampal CA3 region. Key words: Stellate ganglion; Nerve block; Aged; Hippocampus; Synapses

Stellate ganglion block promotes recovery of Bell's palsy in patients with diabetes mellitus

Conclusion: Stellate ganglion block (SGB) is effective for treatment of Bell's palsy in patients with diabetes mellitus. Background: Corticosteroids are widely used for treatment of Bell's palsy in patients with diabetes mellitus but may induce complications like hyperglycemia, which calls for an alternative therapy. This study aimed to ascertain the effect of SGB on Bell's palsy in patients with diabetes mellitus. Methods: This randomized and single-blinded clinical trial involved 96 diabetic patients with Bell's palsy that were randomly divided into a control group (n = 48) and a treatment group (SGB group, n = 48). The House-Brackmann scale and facial disability index (FDI, including FDIP and FDIS) were observed before treatment and at 1 and 3 months after treatment for assessment of the outcome. Results: No statistically significant difference was found between the two groups before treatment as regards the House-Brackmann scale and FDI. There was a statistically significant difference in FDIP score in the two groups after treatment in comparison with before treatment. The FDIS score showed a statistical difference between the two groups after treatment.

The effects of stellate ganglion block on the electroencephalogram in rats

It is reported that the sympathetic nervous system may play an important role in the arousal response. The present study evaluated the effect of stellate ganglion block (SGB) on electroencephalogram (EEG) activity in rats. Adult male Sprague-Dawley rats were divided into two groups: SGB (n = 10) or intramuscular (IM, n = 10) injection was performed with 0.2 ml 0.25 % bupivacaine. The spectral edge frequency 95 % (SEF 95 %), median frequency (MF), beta to theta ratio (BTR), and beta to delta ratio (BDR) were estimated 30 min before bupivacaine injection and 15, 20, 25, 30, 45, 55, and 100 min after SGB or IM injection. Ipsilateral ptosis occurred in all the rats that underwent SGB but did not occur in the IM group. Significant decrease of the 95 % SEF value, MF, BTR, and BDR was observed from 15 to 45 min after SGB compared with those of the IM group, respectively (p < 0.05). SGB with 0.2 ml 0.25 % bupivacaine significantly decreased EEG activities in rats. These results suggest that SGB can induce a sedative effect in rats. Further studies are required to investigate the behavioral tests for sedative effects of SGB.

Effect of stellate ganglion block on cardiomyocyte apoptosis and expression of Bcl-2/Bax protein in spontaneously hypertensive rats

To investigate the relationship between apoptosis of myocardial cells in spontaneously hypertensive rats (SHRs) and the expressions of Bcl-2 and Bax protein, and the protective effect of stellate ganglion block on apoptosis of myocardial cells. A total of 32 ten-week-old male SHRs were assigned randomly into 4 groups: a left stellate ganglion block group (group LS), a right stellate ganglion block group (group RS), a captopril group (group D) and a control group (group C). The arterial systolic blood pressure was measured by ALC-NIBP system. After 10 weeks, all rats were anaesthetized by 3% pentobarbital sodium, cardiomyocyte apoptosis index of left ventricle was assessed by TUNEL, and the localization of myocardium Bcl-2, Bax was investigated by immunohistochemistry. Compared with group LS and C, the apoptotic index decreased (P<0.05). SHR myocardial expression of Bcl-2 significantly increased (P<0.05), Bax expression significantly decreased (P<0.05) and Bcl-2/Bax was significantly higher (P<0. 05) in group RS. Bcl-2 and Bax play an important role in the apoptosis of myocardial cells in SHRs. Right stellate ganglion block can reduce the apoptosis of myocardial cells and reverse the reconstruction of the left ventricle in SHRs via regulation of apoptosis-related gene proteins.

Effect of stellate ganglion block combined with morphine sustained-release tablets for controlling pain of advanced lung cancer

Objective To investigate the effect of stellate ganglion block combined with morphine sustainedrelease tablets for controlling pain of advanced lung cancer.Methods 90 cases with advanced lung cancer were randomly divided into the observation group and control group with 45 cases in each group.The control group was givenmorphine sustained-release tablets,the observation group received combination therapy with stellate ganglion block and morphine sustained-release tablets.The analgesic effects,quality of life scores and adverse reactions of two groups were compared.Results The effective rate of observation group was 93.33 ％ (42/45),which was significantly higher than that of control group 77.78％ (35/45),the difference was statistically significant (x2 =4.54,P ＜ 0.05).The morphine consumption of observation group was significantly less than that of control group(t =9.11,P ＜ 0.05),duration of analgesia was significantly longer than that of control group (t =6.72,P ＜ 0.05).Quality of life score in the observation group was significantly higher than that in the control group,the difference was statistically significant(Z =3.61,P ＜ 0.05).The incidence rate of adverse reactions was 17.78％ (8/45),which was significantly lower than that of the control group 46.67％ (21/45),the difference was statistically significant (x2 =4.54,P ＜ 0.05).Conclusion Stellate ganglion block combined with morphine sustained-release tablets for controlling pain of advanced lung cancer can significantly improve analgesia,reduce morphine consumption and adverse reactions,is worthy of clinical application. Key words: Pain; Analgesia; Lung neoplasms; Stellate ganglion; Ganglionic blockers; Morphine sustained-release tablets