Efficacy Of Stellate Ganglion Block Research Articles

Antiarrhythmic and analgesic efficacy of stellate ganglion block in laparoscopic cholecystectomy

ABSTRACT Background To explore the effect of right stellate ganglion block (RSGB) during laparoscopic cholecystectomy (LC) for control of intraoperative arrhythmia during CO2 pneumoperitoneum and postoperative pain relief Methods Forty patients undergoing LC in our hospital were selected as the subjects and were randomly divided into group S (20 cases) and group C (20 cases), all patients received RSGB, 10 mL of lidocaine 2% under ultrasound guidance to compare the incidence of arrhythmia (1ry outcome), changes of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MBP) in different time points and postoperative visual analogue scale (VAS) was reported in the 1st, 6th, and 12th hours, respectively, with time to first analgesia request. Results Intraoperative arrhythmias was significantly lower in group S rather than group C (P = 0.037); postoperative pain profile revealed that there was a significant difference between the 2 groups presented as longer duration for first time to request analgesia (P = 0.015) and lower VAS scores specially at the 1st and 6th postoperative hours in group S compared to group C (P < 0.001 and 0.004); changes in heart rate and blood pressure, there was a significant difference between the 2 groups in values of both parameters 5 minutes following CO2 insufflation, group S showed significantly lower HR, SBP, and MBP at this time point than group C. Conclusion Patients received RSGB before laparoscopic cholecystectomy can experience lower incidence of arrhythmia, better intraoperative hemodynamics, and effective pain control postoperatively.

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

Efficacy of stellate ganglion block in perioperative period of patients with chronic sinusitis and hypertension

Objective: To observe the perioperative efficacy of stellate ganglion block (SGB) in functional endoscopic sinus surgery (FESS) in chronic sinusitis patients with hypertension. Methods: A total of 60 patients with chronic sinusitis complicated with hypertension who were scheduled to undergo FESS in the Department of Otorhinolaryngology, the First Affiliated Hospital of Soochow University from April 2018 to December 2019 were selected and divided into SGB group and control group by random number table method. SGB were performed at 24 hours before surgery and induction of general anesthesia alternately, while the control group was not treated. During the operation, controlled hypotension were performed in both groups. Hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate (HR) were recorded at 24 hours before surgery(T(0)), before anesthesia induction (T(1)), at the beginning of surgery (T(2)), at the end of surgery (T(3)), and at 24 hours after surgery(T(4)).Plasma epinephrine and norepinephrine concentrations were measured at T(0), T(1), T(3) and T(4). The dosage of anesthesia and other drugs, operative time, bleeding amount and extubation time were recorded, while the quality of the operative field was evaluated. VAS scores were assessed at 1, 6 and 24 hours after surgery. Results: In the SGB group, SBP, DBP and MAP in T(1), T(2), T(3), T(4) and HR in T(1), T(4) were lower than those in the control group (all P<0.05). Compared with T(0), SBP, DBP, MAP and HR in T(1), T(2), T(3), T(4) all decreased in SGB group (all P<0.05); In the control group, SBP, DBP and MAP only decreased in T(2) and T(3), and HR fluctuated significantly (P<0.05). In the SGB group, plasma epinephrine and norepinephrine concentrations at T(1), T(3) and T(4) were lower than those in the control group (P<0.05). Compared with T(0), plasma epinephrine and norepinephrine concentrations in the SGB group fluctuated in positive and negative phases, while those in the control group increased (P<0.05). The pain scores in SGB group at 6 and 24 hours after surgery were 1.3±0.7 and 2.6±0.9, which were lower than 1.7±0.7 and 3.1±0.9 in the control group (t=-2.290, -2.050, all P<0.05). Conclusion: SGB may effectively improve hemodynamics, maintain homeostasis, reduce anesthesia and surgical complications in patients with chronic sinusitis and hypertension in perioperative period.

The effect of superior cervical ganglion resection on peripheral facial palsy in rats.

Stellate ganglion block is performed to treat peripheral facial palsy because it increases blood flow and promotes nerve regeneration. Although stellate ganglion block increases blood flow around the facial nerve that runs outside the temporal bone, it may not affect blood flow inside the bone. Therefore, although stellate ganglion block is an effective procedure when the facial nerve is damaged outside the temporal bone, no studies have investigated the relationship between the site of nerve damage and the therapeutic effect of stellate ganglion block. Here, we investigated the efficacy of stellate ganglion block for facial palsy caused by facial nerve damage both inside and outside the temporal bone in rats. A rat facial palsy model was created with nerve cooling that damaged the facial nerve inside or outside the temporal bone. A rat facial palsy stellate ganglion block model was also created by performing superior cervical ganglion resection on facial palsy model rats, and the duration of paralysis was examined. Facial nerve cooling inside and outside the temporal bone resulted in a mean duration of paralysis of 13.8±1.6days and 18.3±2.2days, respectively. Superior cervical ganglion resection in which the facial nerve had been cooled inside and outside the temporal bone reduced the mean duration of paralysis by 2.4±1.3days and 5.4±1.3days, respectively. Stellate ganglion block was more effective in facial palsy caused by damage to the facial nerve outside, rather than inside, the temporal bone.

Efficacy of Stellate Ganglion Block in the Treatment of Anxiety Symptoms From Combat-Related Post-Traumatic Stress Disorder: A Case Series

Report the efficacious use of stellate ganglion blocks (SGBs) in treating the anxiety symptoms of four patients diagnosed with combat-related post-traumatic stress disorder (PTSD) and discuss possible mechanisms of action to explain these findings. Successful treatment of PTSD with SGB has been demonstrated and reported previously at Walter Reed Army Medical Center. An identical protocol was used at Tripler Army Medical Center to treat four service members diagnosed with combat-related PTSD. All patients reported received an SGB on the right side at the level of C6. The patient's PTSD symptoms were evaluated using the Post-traumatic Stress Disorder Checklist (PCL). This checklist was distributed one day before treatment and again the day following treatment. The patients were also given the PCL at subsequent follow-up visits to quantify sustained benefit. SGB showed acute benefit for the symptoms of PTSD by markedly reduced PCL scores after the procedure. Benefits were also sustained during close outpatient follow-up. Selective blockade of the right stellate ganglion at C6 is a minimally invasive procedure with an excellent safety profile that may provide sustained relief of PTSD symptoms. The procedure may also provide benefit for those who are resistant to psychotropic intervention.

Efficacy of Stellate Ganglion Block in Cholinergic Urticaria with Acquired Generalized Hypohidrosis

Cholinergic urticaria with acquired generalized hypohidrosis, and its pathophysiology is not well known. Autoimmunity to sweat glands or to acetylcholine receptors on sweat glands has been mentioned as one of the possible etiologies. Systemic steroid therapy, antihistamines, anticholinergics, and avoidance of the stimulatory situations are recommended for treatment. We experienced a case of cholinergic urticaria with acquired generalized hypohidrosis in a patient who had no other associated disease, and the symptoms eased after repeated bilateral stellate ganglion block. Stellate ganglion block normalized the elevated sympathetic tone and may relieve symptoms in patients with this condition.

Clinical study on stellate ganglion block for the treatment of primary dysmenorrhea

Objective To investigate the efficacy of stellate ganglion block (SGB) as treatment in primary dysmenorrheal (PD) patients and the possible mechanism. Methods A total of 76 PD patients were referred to our clinic from October 2007 to June 2011.All of them received SGB switching from left to right ganglion once daily from 7 days before through 3 days after menstrual period in 3 consecutive menstruation cycles.The visual analog scale (VAS) and sleep interference scale (SIS) were recorded within 24 hours after the last untreated menstruation (T0),the 1st treated menstruation (T1),the 2nd treated menstruation (T2),the 3rd treated menstruation (T3),and the 3rd menstruation after treatment (T4),respectively.In addition,the serum prostaglandin F2α (PGF2α) level and prostaglandin F2α/prostaglandin E2 (FGE2α/FGE2)ratio were measured at the above time points.Results The VAS scores at T1,T2,T3 and T4 were (1.83±0.52),(1.48±0.21),(1.25±0.14),(1.30±0.25),respectively,which were significantly less than that at T0 (6.35±1.42)(P＜0.01 ).The SIS scores at T1,T2,T3 and T4 were (1.52±0.41),(1.40±0.22),(1.12±0.11),( 1.33±0.24),respectively,which were significantly less than that at T0 (6.55±1.32) (P＜0.01).The serum PGF2α and PGF2α/PGE2 ratio at T1,T2,T3 and T4 were(5.1±1.1 ) μg/L and (2.1±1.3),(4.9±1.2),(1.9±1.4),(4.8±1.6) μg/L,(1.8±1.1),(4.9±1.7) μg/L and (2.1±1.3),respectively,which were significantly less than that at T0 (15.3±2.1),(5.2±1.6) (P＜0.01). Conclusions SGB is effective in pain relief and sleep improvement for PD patient,which may be associated with the reduction of serum PGF2α level and PGF2α/PGE2 ratio. Key words: Stellate ganglion block; Primary dysmenorrhea; Visual analog scale; Sleep interference scale

Use of perfusion index from pulse oximetry to determine efficacy of stellate ganglion block

BackgroundStellate ganglion block (SGB) is a widely used procedure for treatment of pain in the head and upper body, but the clinical signs used to verify the effectiveness of SGB can be ambiguous or variable in some patients. We observed the chronological changes in perfusion index (PI) from pulse oximetry to determine if these changes correlated with the clinical signs associated with an effective SGB. We hypothesized that PI could provide an easy method to assess the effectiveness of SGB.MethodWe compared the chronologies in PI on the treated and untreated sides of 21 patients in whom treatment by SGB was found to be effective. The SGB was performed by administering 6 mL of 1% mepivacaine. The effectiveness of the SGB was confirmed on the basis of clinical signs. Additionally, in two patients we tested whether increased PI on the treatment side correlated with increased microcirculation as measured by laser-Doppler blood flowmetry.ResultsOn the side treated by SGB, PI increased 61.4% in the earlobe and 60.5% from baseline values in the upper limbs, at 5 minutes after initiation of the procedure. Differences in PI before and after treatment were significant at both sites. No time-course increases in PI were found on the untreated side at either site. Following SGB, increases in PI correlated with increases in blood flow as measured by laser-Doppler flowmetry.ConclusionPI increased in the earlobe and upper limbs on the treated side of 21 patients who received an effective SGB but not on the untreated side. The positive correlations between changes in PI and both presence of clinical signs and changes in blood flow in the skin microcirculation indicate a sympatholytic effect, suggesting that the PI could be useful in determination of the efficacy of SGB.

Efficacy of stellate ganglion block with an adjuvant ketamine for peripheral vascular disease of the upper limbs

Stellate ganglion block (STGB) is commonly indicated in painful conditions like reflex sympathetic dystrophy, malignancies of head and neck, Reynaud’s disease and vascular insufficiency of the upper limbs. The sympathetic blockade helps to relieve pain and ischaemia. Diagnostic STGB is usually performed with local anaesthetics followed by therapeutic blockade with steroids, neurolytic agents or radiofrequency ablation of ganglion. There is increasing popularity and evidence for the use of adjuvants like opioid, clonidine and N Methyl d Aspartate (NMDA) receptor antagonist – ketamine – for the regional and neuroaxial blocks. The action of ketamine with sympatholytic block is through blockade of peripherally located NMDA receptors that are the target in the management of neuropathic pain, with the added benefit of counteracting the “wind-up” phenomena of chronic pain. We studied ketamine as an adjuvant to the local anaesthetic for STGB in 20 cases of peripheral vascular disease of upper limbs during the last 5 years at our institution. STGB was given for 2 days with 2 ml of 2% lignocaine + 8 ml of 0.25% bupivacaine, followed by block with the addition of 0.5 mg/kg of ketamine for three consecutive days. There was significant pain relief of longer duration with significant rise in hand temperature. We also observed complete healing of the gangrenous fingers in 17/19 patients.

Facial Pain: A Possible Therapy with Stellate Ganglion Block

The goal of the present study is to verify the efficacy of stellate ganglion block (SGB) in the treatment of facial pain that can be found in different pathological syndromes, and also to examine whether the efficacy is dependent upon when this therapy is administered. Fifty patients (divided into two randomized groups) with facial pain caused by traumas, iatrogenic issues, herpes zoster, or neurological pathologies participated in this study. The first group (N = 25) was treated with SGB produced by 10 administrations of 10 mg of levobupivacaine given every other day, followed by one administration per month for 6 months thereafter. The second group was treated with the drugs tramadol 100 mg/day and gabapentin 1800 mg/day orally for 6 months; during the 7th month they were given SGB therapy using the same methodology as that described for the first group. Before treatment, the mean visual analog scale (VAS) pain score for the first group was 8.89; after the 10th block treatment it was just 0.2, and it remained at that reduced level for the 6th and 12th months. Before treatment, the mean VAS pain score for the second group was 8.83; after the 20th day on medication it was reduced to 4.1, after 6 months it was 5.7 and after 12 months it was 4.9. Our results indicate that patients must be treated with SGB therapy precociously to receive its full benefits.

The Efficacy of Stellate Ganglion Block in Sensorineural Anosmia Patients Unresponsive to Steroid Therapy

Background: Anosmia can be frustrating for both the patient and physician, with no clear treatment. We prospectively investigated the effects of stellate ganglion block (SGB) in anosmic patients who were unresponsive to conventional steroid therapy. Methods: Thirteen patients with anosmia were treated with SGB. To evaluate the improvement in olfactory function, we evaluated both changes in subjective symptoms and the butanol threshold test. The number of SGB required for improvement in olfactory function was counted. Results: Seven patients (54%) showed improvement of olfactory function with SGB. The average number of SGB for the first response was 7.4 ± 5.9 times. Conclusions: These results suggest that SGB may be a good treatment modality for patients with anosmia unresponsive to steroid therapy. (Korean J Pain 2007; 20: 154�� 157)

Stellate Ganglion Blockade for Acute Postoperative Upper Extremity Pain

Baystate Medical Center and the Tufts University School of Medicine, Springfield, Massachusetts. scott.reuben@bhs.orgI appreciate the comments by Drs. Kakazu and Julka. Although the role of the sympathetic nervous system in certain chronic pain states, including complex regional pain syndrome (CRPS), has been well documented,1,2its role in acute pain and inflammation is still controversial.3,4A coupling between the sensory afferent and sympathetic efferent system after peripheral nerve lesions has been previously described as a causative mechanism for neuropathic pain, including CRPS.1,2However, the role of the sympathetic nervous system in acute pain still must be elucidated. The sympathetic nervous system may influence the nociceptive response to acute tissue injury in two ways.4First, there is a potentiation of the chemical mediator cascade after trauma as well as augmentation of sensitization to substance P. Second, norepinephrine and α2agonism in the dorsal horn neurons and in the locus ceruleus in the medulla play a major role in the descending medullospinal inhibition of nociception. Experimental studies in rats indicate that sympathetic postganglionic neurons may be involved in the generation of pain, hyperalgesia, and inflammation after tissue damage or trauma.5,6Sensitization of nociceptive afferent fibers in the knee joints of rats involves a cascade of events in which the mast cell and the sympathetic terminal are sequentially activated, resulting in plasma extravasation in the synovium.5,6Further, adrenal medullary-derived epinephrine can exacerbate and surgical or pharmacologic sympathectomy can decrease the severity of experimental arthritis.5Although these behavioral studies in rats point to a potential role of the sympathetic nervous system in acute inflammatory pain, neurophysiologic studies of nociceptors in rats and psychophysical studies in humans have failed to provide confirmatory evidence for the role of sympathetic efferents in inflammatory pain and hyperalgesia.3The use of a stellate ganglion block for acute postoperative pain as described by Drs. Kakazu and Julka is intriguing. I agree with the authors that because this patient sustained his fracture 1 week before surgical correction, prolonged sensitization and alteration of nociceptive afferent pathways may have increased the risk for the development of postsurgical CRPS. However, the authors did not report whether this patient had any clinical symptoms consistent with CRPS before surgical intervention. Perhaps the surgical intervention exacerbated an underlying disease process that may have been initiated before surgery. Interestingly, since the success of our original report on the efficacy of stellate ganglion blocks for CRPS patients undergoing surgery,7many of our surgeons now request that we routinely perform this sympathetic block for non-CRPS patients who are undergoing surgical procedures and are at increased risk for development of this disease. Although stellate ganglion block may be effective for treating acute postoperative neuropathic pain, it may also be useful in the management of acute nociceptive pain. Matsuura et al. 8describe the efficacy of stellate ganglion block in 29 patients undergoing ocular surgery. These authors report a significant reduction in postoperative pain and nonsteroidal antiinflammatory drugs with the use of stellate ganglion block. These case studies highlight the importance of moving from symptom control toward a mechanism-specific pharmacologic management of postoperative pain.9We have only begun to identify the multiple neurobiologic mechanisms responsible for different pain states. We hope to be able to develop diagnostic tools that will allow us to identify these mechanisms in individual patients and target them with appropriate analgesic interventions. Future research is needed in defining the clinical significance of the interaction of the sympathetic nervous system and the somatic afferent system in the development of postoperative pain. At that time, we may have available not only the resources for eliminating acute pain but also the tools necessary for preventing the occurrence of chronic postsurgical pain.Baystate Medical Center and the Tufts University School of Medicine, Springfield, Massachusetts. scott.reuben@bhs.org

MULTIDISCIPLINARY PAIN ABSTRACTS: 13 . Anesthesia (13)

This study was conducted to evaluate whether the neck skin crease is a reliable indicator of the C6 level. Forty‐nine relatively obese pain clinic patients were investigated. They assumed a standard position for stellate ganglion block (SGB). A radiopaque wire was placed along the neck skin crease caudad to the thyroid cartilage. Next, a radiopaque indicator was placed on the skin above the tubercle found to be most prominent by palpation. X‐rays of the neck were obtained after each procedure. The probability that the neck crease would cross C5, C6, and C7 was 16%, 71%, and 12%, respectively. The most prominent tubercle corresponded to the C5, C6, and C7 levels in 16%, 69%, and l4% of cases, respectively. The studied means to identify the C6 transverse process was found to correlate well with each other (p &lt; 0.001). As the C6 process could not be identified by any of the studied means in 30% of cases, radiological guidance is recommended in order to ensure optimal safety and efficacy of SGB in selected cases.

The neck crease as a landmark of Chassaignac's tubercle in stellate ganglion block: anatomical and radiological evaluation.

Stellate ganglion block (SGB) is most commonly performed at the transverse process of the sixth cervical vertebra, the identification of which could be difficult in patients with short and wide necks. This study was conducted to evaluate whether the neck skin crease is a reliable indicator of the C6 level. Forty-nine relatively obese pain clinic patients were investigated. They assumed a standard position for SGB. A radiopaque wire was placed along the neck skin crease caudad to the thyroid cartilage. Next, a radiopaque indicator was placed on the skin above the tubercle found to be most prominent by palpation. X-rays of the neck were obtained after each procedure. The probability that the neck crease would cross C5, C6 and C7 was 16%, 71%, and 12%, respectively. The most prominent tubercle corresponded to the C5, C6 and C7 levels in 16%, 69% and l4% of cases, respectively. The studied means to identify the C6 transverse process was found to correlate well with each other (P<0.001). Since in 30% of cases the C6 process could not be identified by any of the studied means, radiological guidance is recommended in order to ensure optimal safety and efficacy of SGB in selected cases.

Stellate ganglion block for the relief of tinnitus in vibration disease.

Vibration disease results from the long-term use of vibratory tools such as chain-saws and pneumatic hammers. Vibration, noise, and cold are stressors that impair the human body. Consequently, signs and symptoms can occur, including tinnitus which can be associated with hearing loss. Tinnitus occurs in approximately 40% of the patients, and is hard to effectively treat. Stellate ganglion block was performed in patients with tinnitus. The efficacy of the ganglion block was evaluated by the five steps' method of patient self-assessment and by the audiometric method. The effective rates of the ganglion block for tinnitus was 62.5% by self-assessment and 68.8% by audiometric assessment. The hearing acuity partially recovered and was associated with good or partial relief of tinnitus. A follow-up study for 18 months revealed that the efficacy of stellate ganglion block for tinnitus persisted. Thus, stellate ganglion block therapy can be effective for the treatment of tinnitus in patients with vibration disease.