Ganglion Block In Patients Research Articles

Analysis of the Necessity of Stellate Ganglion Block after Anesthesia to Reduce the Risk of Cardiovascular Accidents in Coronary Heart Disease

Objective: To adjust the sympathetic nervous system through preoperative ultrasound-guided stellate ganglion block and to explore and analyze the situation and necessity of postanesthesia stellate ganglion block to reduce the risk of cardiovascular accidents in coronary heart disease. Methods: 80 patients with cardiovascular risk factors in Songshan Hospital of Chifeng were selected, and the time span would cover from October 2022 to June 2024, with 80 cases of elective surgery and combined coronary heart disease. They will be randomly divided into blocked groups and conventional groups, 40 cases each. Conventional block was performed after anesthesia in patients in the conventional group, and planetary ganglion block was performed after anesthesia in patients in the blocked group. The cardiovascular responses of patients in the two groups were observed, and the number of intraoperative cardiovascular active drugs and the occurrence of cardiovascular adverse events were recorded in patients in the two groups. Results: Analysis of the mean arterial pressure (MAP) and heart rate (HR) values of the two groups of patients at the time points before anesthesia (T0), the moment of tracheal intubation (T1), the moment of surgical skin cutting (T2), the end of the operation (T3), and the 6h postoperative period (T4) showed that the MAP and HR of the blocked group were lower than those of the conventional group at the time points of T1 to T4, and the differences in MAP and HR values of the two groups in different time points compared with the T0 time point were statistically significant (P < 0.05) and the differences in cardiovascular response (P < 0.05) were statistically significant (P < 0.05). significance (P < 0.05). The number of intraoperative cardiovascular active drugs used in the blocked group was shorter than that in the conventional group, and the incidence of cardiovascular adverse events was lower than that in the conventional group, with a statistically significant difference (P < 0.05). Conclusion: By implementing preoperative ultrasound-guided stellate ganglion block in patients with cardiovascular risk factors, the frequency and degree of coronary heart disease symptoms will be reduced, thus reducing the risk of patients, which is worth promoting.

Stellate Ganglion Block in Patients with Subarachnoid Hemorrhage: Systematic Review & Meta-analysis (P2-5.025)

Stellate Ganglion Block in Patients with Subarachnoid Hemorrhage: Systematic Review & Meta-analysis (P2-5.025)

Use of Bioelectrical Impedance Analysis to Explore the Effectiveness of Stellate Ganglion Block in Patients with Post-Stroke Complex Regional Pain Syndrome: A Retrospective Pilot Study.

Post-stroke complex regional pain syndrome (CRPS) poses challenges in pain assessment for survivors. Stellate ganglion block (SGB) is a treatment, but evaluating its effectiveness is difficult for patients with communication limitations. Edema, a prominent symptom, can serve as an evaluation marker. Bioelectrical impedance analysis (BIA), assessing body composition and fluid status, is used independently of patient cooperation. This retrospective, observational pilot study aims to explore BIA's utility as an assessment tool post-SGB, revealing the effects and time courses of a single SGB on the bodily composition of post-stroke CRPS patients. Seven patients received ultrasound-guided SGB with a 5 mL solution containing 4 mL of 0.25% bupivacaine hydrochloride and 40 mg of triamcinolone into the prevertebral muscle space. BIA compared measures between affected and unaffected arms. The affected arm had higher segmental body water (SBW) and extracellular water ratios before SGB (p = 0.028 and p = 0.018, respectively). The SBW of the affected side, the SBW ratio, and the 1 and 5 kHz SFBIA ratios improved over time (p = 0.025, 0.008, 0.001, and 0.005, respectively). Rapid improvement occurred around 3 days post-injection, with maximum effects within approximately 1 week, persisting up to 3 weeks. SGB successfully reduced edema in post-stroke CRPS patients, with BIA serving as a useful tool for follow-up, facilitating the development of efficient treatment plans.

Time for a new destination: foregoing surgical sympathectomy after successful stellate ganglion block in patients with refractory ventricular tachycardia

Abstract Background Electrical storm (ES) is defined as >3 episodes of sustained ventricular arrhythmias in 24 hours and is associated with increased mortality. ES portends a poor prognosis with limited effective treatment options. Stellate ganglion block (STGB) can be used in patients with ES for temporary control of VT. When STGB is successful, patients can be referred for surgical sympathectomy for longer term management. We postulated that STGB can be used as a bridge to other treatments for refractory VT. Purpose To evaluate the efficacy of STGB as a bridge to interventions other than surgical sympathectomy in patients with refractory VT. Additionally, we assessed STGB as an adjunctive therapy to medical optimization when the cause for ES is temporary (e.g., QT prolonging medications, acute ischemia) foregoing the need for long term interventions. Methods This is a single center retrospective study. We enrolled 12 consecutive patients admitted from July 2018 to September 2022 for ES that received a STGB. The primary clinical outcome was cessation of VT for 24 hours beginning 1 hour after STGB was performed. Secondary clinical outcome of the study was freedom from VT until discharge after STGB. Primary safety outcomes were major procedural complications or death within 48 hours after STGB. Results Sixty-seven percent of the patients were male, with a mean age of 58 years and an average left ventricular ejection fraction of 32%. Two-thirds of the patients had ischemic VT of which half were status post CABG and the other half were status post PCI. In the first 24 hours after STGB, 91% of patients were without recurrent VT. Fifty percent of patients did not have recurrent VT from 24 hours after SGB was performed until discharge. Three patients were referred for catheter ablation. No patients received surgical sympathectomy. There were no major complications or deaths within 48 hours of STGB. Conclusion STGB is a safe and effective procedure that can be utilized as a bridge to VT interventions other than surgical sympathectomy. For patients with ES, STGB is also effective at temporarily suppressing VT allowing time for medical optimization and the withdrawal of provoking agents which perpetuate ES. Further research is necessary to determine optimal timing and patient selection for STGB when used as a bridge for alternative VT therapies.Clinical Impact of VT after STGBElectrical Storm Characteristics

Efficacy and safety of percutaneous left stellate ganglion block in patients with refractory electrical storm: our five years experience

Abstract Background Neuromodulation by percutaneous stellate ganglion block (PSGB) with local anaesthetic has proven its antiarrhythmic effect suitable for an emergency setting. Purpose To assess the efficacy and safety of PSGB performed with an anterior anatomical approach in patients with refractory electrical storm. Methods Patients with electrical storm were enrolled from November 2017 to December 2022. Left PSGB (PLSGB) was performed after failure of at least one intravenous antiarrhythmic drug. Its repetition or a continuous infusion of the local anaesthetic were considered in selected cases. Clinical data, characteristics of the block and complications were collected. The efficacy was evaluated by comparing the number of arrhythmias treated with ATP or DC-shocks by external or internal defibrillator in the hour before the block with that in the hour after the block. Per-patient efficacy was assessed by comparing the number of ATP/shocks in the 12 hours before the first procedure with that in the 12 hours after the last one. Results 37 patients were enrolled: 76% male, mean age 65 years; 11 with dilated cardiomyopathy, 18 with chronic ischemic heart disease, 11 with ST-elevation myocardial infarction, 3 with non-ST-elevation myocardial infarction, 1 with arrhythmogenic right ventricular cardiomyopathy and 1 with drug intoxication. A total of 62 PLSGBs were performed: 19 for ventricular tachycardia (VT), 26 for ventricular fibrillation (VF) and 17 for both VT and VF episodes; 15 on intubated patients, 4 in extracorporeal circulation, 14 in refractory cardiac arrest, 7 in cardiogenic/septic shock, 28 on patients on single antiplatelet therapy, 11 on dual antiplatelet therapy, 33 on anticoagulant therapy. PLSGBs were performed during intravenous infusion of antiarrhythmics (amiodarone in 30, lidocaine in 37 procedures). The local anaesthetic used was lidocaine in 27/62 PLSGB, bupivacaine in 6/62 and both in 29/62. The per-procedure analysis showed a significant reduction of the number of ATP/shocks in the hour after PLSGB compared with the hour before [0 (0-0) vs 5 (1-8) p<0.001]. Similarly, in the per-patient analysis, the number of ATP/shocks significantly decreased in the 12 hours after the PLSGB compared with that in the 12 hours before [0 (0-1.3) vs 7 (4.8-12.5) p<0.001]. No complications occurred. Conclusions This case series reports our five years experience in performing PLSGB for antiarrhythmic purpose and it confirms its efficacy and safety in the treatment of refractory electrical storm. In particular, the anatomical approach requires few tools and can be easily performed at the bedside.

Successful Stellate Ganglion Block in Patients with Treatment Resistant Post-Traumatic Stress Disorder: A Case Series and Recent Literature Review

BACKGROUND: Post-traumatic stress disorder (PTSD) is an increasing health concern in both those with and without previous military experience. There is a growing body of evidence for the use of stellate ganglion block (SGB), a procedure performed to treat pain conditions and cardiac arrythmias, in the treatment of PTSD. There have been multiple clinical studies, randomized and nonrandomized, that have demonstrated positive results for the use of SGB. CASE REPORT: In this case series, we present 3 patients with military background and treatment resistant PTSD who underwent SGBs. All 3 patients experienced a decrease in their clinical symptoms and improved quality of life. CONCLUSION: Patients with refractory PTSD may benefit from SGB for treatment of their symptoms. PTSD symptoms may be sympathetically mediated, lending to the effect of SGB for symptom management. Data from recent clinical trials demonstrate a statistically significant reduction in PTSD symptoms when compared to sham procedures. KEY WORDS: Case series, literature review, local anesthetic, post-traumatic stress disorder, randomized control trial, stellate ganglion block, superficial cervical ganglion block, trauma

Local Anesthetics for Sphenopalatine Ganglion Block in Patients Undergoing Endoscopic Septoplasty

Local Anesthetics for Sphenopalatine Ganglion Block in Patients Undergoing Endoscopic Septoplasty

The analgesic effect of lumbar sympathetic ganglion block in patients with failed back surgery syndrome.

Persistent or recurrent lumbosacral pain is a common symptom after spinal surgery. Several interventions have been introduced for failed back surgery syndrome; however, their clinical efficacy, safety, and cost-effectiveness are insufficient. Sympathetic ganglion block has been selected for pain associated with the sympathetic nervous system. In this study, we compared pain and quality of life in patients with failed back surgery syndrome who responded and did not respond to lumbar sympathetic ganglion block. We included 84 patients diagnosed with failed back surgery syndrome who had lumbosacral pain and underwent lumbar sympathetic ganglion block between January 2020 and April 2021. The patients' data were retrospectively analyzed; clinical outcomes were assessed before (T0), 1 week after (T1), and 4 weeks after (T4) lumbar sympathetic ganglion block. Based on the pain difference from T0 to T1, we categorized patients into two groups: patients with ≥ 50% pain reduction (responder group) and patients with < 50% pain reduction (non-responder group). Demographic, clinical, surgical, and fluoroscopic data were evaluated and compared. The primary outcome was pain scores and the EuroQol-5D score from T0 to T4. Among the 84 patients analyzed, 41 (48.8%) experienced ≥ 50% pain reduction at 1 week after lumbar sympathetic ganglion block. Lumbar sympathetic ganglion block significantly improved pain at T1 and T4 compared to T0 in both groups. Lumbar sympathetic ganglion block improved the EuroQol-5D score at T1 compared to T0 in the responder group. The responder group had a significant decrease in pain at T1 from T0 and T4 from T0 and a significant decrease in the EuroQol-5D score at T1 from T0 compared with the non-responder group. Coldness of the leg over time did not differ between the groups. No serious adverse events occurred in either of the groups. Lumbar sympathetic ganglion block may improve pain at 1 and 4 weeks in patients with failed back surgery syndrome. Patients with ≥ 50% pain reduction at 1 week showed simultaneous improvement in quality of life and pain reduction at 4 weeks. https://cris.nih.go.kr/cris/index/index.do, identifier KCT0007236.

Anatomical-based percutaneous left stellate ganglion block in patients with refractory electrical storm: efficacy and safety

Abstract Background The autonomic system plays a pivotal role in ventricular arrhythmogenesis. Percutaneous stellate ganglion block (PSGB) is a technique known since many years for analgesic purposes, which has recently proven its antiarrhythmic effect suitable for an emergency setting. However, evidences are limited and heterogeneous. Purpose To assess the efficacy and safety of PSGB performed with an anterior paratracheal approach using anatomical landmarks in consecutive patients with electrical storm refractory to conventional treatment. Methods Patients with electrical storm were consecutively enrolled from November 2017 to January 2022. Left PSGB (PLSGB) was performed after failure of at least one intravenous antiarrhythmic drug. Its repetition or a continuous infusion of the local anaesthetic were considered in selected cases. Clinical data, the characteristics of the block and the occurrence of complications were collected. The efficacy was evaluated by comparing the number of arrhythmias treated with ATP or DC-shocks by external or internal defibrillator in the hour before the block with that in the hour after the procedure. Per-patient efficacy was assessed by comparing the number of ATP/shocks in the 24 hours before the procedure with that in the 24 hours after the last procedure. Results 28 patients were enrolled: 78% male, mean age 65.4±14.2 years; 9 with dilated cardiomyopathy, 8 with chronic ischemic heart disease, 7 with ST-elevation myocardial infarction, 2 with non-ST-elevation myocardial infarction, 1 with arrhythmogenic right ventricular dysplasia and 1 with drug intoxication; the average ejection fraction was 24.2±15%. A total of 44 PLSGBs were performed: 18 for ventricular tachycardia (VT), 11 for ventricular fibrillation (VF) and 15 for both VT and VF episodes; 7 on intubated patients, 3 in extracorporeal circulation, 7 in cardiogenic/septic shock, 22 on patients on single antiplatelet therapy, 7 on dual antiplatelet therapy, 25 on anticoagulant therapy. PLSGBs were performed during intravenous infusion of antiarrhythmics (amiodarone in 24, lidocaine in 27 procedures). The local anaesthetic used was lidocaine 200 mg in 16/44 PLSGB, bupivacaine 50 mg in 4/44 and both in 24/44. The per-procedure analysis showed a significant reduction of the number of ATP/shocks in the hour after PLSGB compared with the hour before [0 (0–0) vs 5 (1–8) p&amp;lt;0.001]. Similarly, in the per-patient analysis, the number of ATP/shocks significantly decreased in the 24 hours after the PLSGB compared with that in the 24 hours before [0 (0–1.5) vs 6.5 (4.5–15.5) p&amp;lt;0.001]. No complications occurred. Conclusions This is the largest case series so far in which PLSGB has proven to be highly effective and safe in the treatment of challenging patients with refractory electrical storm. Its safety and the exiguity of the equipment required for the anatomical approach make PLSGB a technique that can be easily performed by cardiologists at the bedside. Funding Acknowledgement Type of funding sources: None.

A randomized control study to assess the efficacy of the sphenopalatine ganglion block in patients with post dural puncture headache.

Post dural puncture headache (PDPH) delays discharge from hospital. We studied the efficacy of sphenopalatine ganglion (SPG) block, a novel technique in management of PDPH using 0.25% Ropivacaine. Forty patients presenting with PDPH after urological procedures under spinal anaesthesia were randomized into two groups: Group C and Group S. Group C received conservative treatment with bed rest, adequate hydration and caffeine 200 mg 6th hourly. Group S patients received SPG block (packing bilateral nostril for 10 minutes with 0.25% Ropivacaine). Inj Paracetamol 1 g IV was given as primary analgesic. Intravenous Diclofenac 75 mg was administered as rescue analgesic. Patients were monitored for 72 hours. Total analgesic requirement, time to attain adequate pain relief, headache pain score, patient satisfactory score were compared between the two groups. We compared the PDPH severity score for headache using 5-point scale method and patient satisfaction score using Likert-type scale. Demographic data, onset of PDPH, needle size, intervention time were statistically insignificant. Total paracetamol consumption was significantly reduced in SPG group. Headache pain score was significantly low in Group S up to 54 hours. Patient satisfaction score was statistically better in Group S. Mean block onset time was 12 minutes. One patient in Group C required Epidural blood patch. SPG block is an effective alternative in managing patients with PDPH. The need for epidural blood patch is greatly reduced using SPG block. Procedural safety, immediate and sustained pain relief make it an evolving treatment modality for PDPH.

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.

Subfascial versus extrafascial ultrasound-guided stellate ganglion block in patients with post-mastectomy sympathetically mediated pain: A randomized clinical trial.

Despite being a well-described intervention, the optimal anatomical approach to perform a stellate ganglion block (SGB) has been disputed. We compared the subfascial and extrafascial ultrasound-guided (USG) SGB. A randomised clinical trial was conducted, consisting of 50 patients in two groups. Group I received SGB via the subfascial approach while Group II received an SGB via the extrafascial approach. The primary endpoint was successful sympathetic blockade (as indicated by a measured temperature rise of ≥2°C). Secondary endpoints included analgesic efficiency (extent of early onset of pain relief as indicated by >50% improvement in Visual Analogue Scale (VAS) score at 300's post-procedure); occurrence of Horner's syndrome; extent of local anaesthetic distribution; and adverse events. The mean increase in sympathetic blockade was significantly higher in the subfascial group (2.6 ± 0.6°C; p = .003). Analgesic efficacy was also significantly higher in the subfascial group (p < .001). The difference in the average dermatomal spread of local anaesthetic down to T2 and up to C4 between the groups was also statistically significant (p = .021 and p = .019, respectively). The degree of temperature rise, pain relief and occurrence of Horner's syndrome were higher in the subfascial than the extrafascial group. The subfascial approach to SGB, with a limited volume of local anaesthetic agent, is a more reliable technique when compared to the extrafascial approach.

Efficacy and mechanism of stellate ganglion block in patients undergoing carotid endarterectomy.

Carotid endarterectomy (CEA) is an effective technique for carotid artery stenosis and has been widely used. Stellate ganglion block (SGB) has good effect on the treatment of both painful and non-painful diseases. To investigate the efficacy of SGB in terms of cerebral protection in patients undergoing CEA and to analyze its mechanism. In this retrospective analysis, 120 patients who underwent CEA were enrolled and divided into study group (SG) (60 cases, general anesthesia and SGB) and control group (CG) (60 cases, general anesthesia). The differences in hemodynamic indexes, middle cerebral artery (MCA) hemodynamic indexes, and endocrine-related indexes between the two groups at the baseline, after induction of anesthesia (induction), and skin incision (incision) were compared. The differences in neurological function and pain level between two groups 1day pre-operatively (pre-op 1), 1day postoperatively (POD 1), 2day postoperatively (POD 2), and 7day postoperatively (POD 7) were also evaluated. Perioperative adverse events and intraoperative anesthetics dosage were compared between two groups. The systolic blood pressure, diastolic blood pressure, mean pulse pressure difference, and heart rate of SG at incision were lower than those of the CG (p < 0.05); Vs, Vd, and Vm of MCA were significantly higher in the SG than in CG at induction and incision (p < 0.05). Cortisol and aldosterone levels were lower and potassium and insulin levels were higher in the SG than in CG at induction and incision (p < 0.05); At pre-op 1, POD 1, POD 2, and POD 7, the VAS scores of patients in the SG were significantly lower than those in CG at POD 1, POD 2, and POD 7 (p < 0.05). The patients in SG showed decreased incidence of perioperative adverse events compared with the CG (p < 0.05); The consumption of anesthetics in the SG was lower than that in CG (p < 0.05). SGB in patients undergoing CEA treatment can improve perioperative cerebral blood supply and reduce the consumption of anesthetics and the incidence of perioperative adverse events, which is safe and feasible as a cerebral protection measure. Meanwhile, SGB may also help stabilize patients' perioperative hemodynamic indexes, but the result still needs to be supported by further large sample data.

Clinical Study of Stellate Ganglion Block in Patients with Sequelae of Ischemic Stroke

Clinical Study of Stellate Ganglion Block in Patients with Sequelae of Ischemic Stroke

Botulinum Toxin Type A for Lumbar Sympathetic Ganglion Block in Complex Regional Pain Syndrome: A Randomized Trial.

The present study was designed to test the hypothesis that botulinum toxin would prolong the duration of a lumbar sympathetic block measured through a sustained increase in skin temperature. The authors performed a randomized, double-blind, controlled trial to investigate the clinical outcome of botulinum toxin type A for lumbar sympathetic ganglion block in patients with complex regional pain syndrome. Lumbar sympathetic ganglion block was conducted in patients with lower-extremity complex regional pain syndrome using 75 IU of botulinum toxin type A (botulinum toxin group) and local anesthetic (control group). The primary outcome was the change in the relative temperature difference on the blocked sole compared with the contralateral sole at 1 postoperative month. The secondary outcomes were the 3-month changes in relative temperature differences, as well as the pain intensity changes. A total of 48 participants (N = 24/group) were randomly assigned. The change in relative temperature increase was higher in the botulinum toxin group than in the control group (1.0°C ± 1.3 vs. 0.1°C ± 0.8, respectively; difference: 0.9°C [95% CI, 0.3 to 1.5]; P = 0.006), which was maintained at 3 months (1.1°C ± 0.8 vs. -0.2°C ± 1.2, respectively; P = 0.009). Moreover, pain intensity was greatly reduced in the botulinum toxin group compared with the control group at 1 month (-2.2 ± 1.0 vs. -1.0 ± 1.6, respectively; P = 0.003) and 3 months (-2.0 ± 1.0 vs. -0.6 ± 1.6, respectively; P = 0.003). There were no severe adverse events pertinent to botulinum toxin injection. In patients with complex regional pain syndrome, lumbar sympathetic ganglion block using botulinum toxin type A increased the temperature of the affected foot for 3 months and also reduced the pain.

The Successful Use of Left-sided Stellate Ganglion Block in Patients That Fail to Respond to Right-sided Stellate Ganglion Block for the Treatment of Post-traumatic Stress Disorder Symptoms: A Retrospective Analysis of 205 Patients.

Ultrasound-guided stellate ganglion block (SGB) is an injection of local anesthetic (8mL of 0.5% ropivacaine) in the neck to temporarily block the cervical sympathetic trunk which controls the body's fight-or-flight response. This outpatient procedure takes less than thirty minutes and is immediately effective. Our goal was to determine if a left-sided stellate ganglion block is effective for treating posttraumatic stress disorder (PTSD) symptoms. While right-sided SGB has been extensively studied, left-sided SGB has not been formally evaluated for this indication. Our hypothesis was that patients who fail to improve following a right-sided SGB will report significant improvement following a left-sided SGB. A retrospective chart review was conducted for patients who received SGB for PTSD symptoms between August 2019 and March 2020. All procedures were performed at an established musculoskeletal practice by the same anesthesia/pain fellowship-trained physician. Subjects included those who underwent a left-sided SGB (LSGB) only after non-response to a right-sided SGB (RSGB). Non-response was defined as less than 10 points of improvement on a PTSD Checklist (PCL-5). Out of 205 patients, 20 did not respond to an RSGB and were included in our analysis. Ten of these patients subsequently received an LSGB, and 90% responded favorably (PCL-5 mean improvement = 28.3 points). Based on our sample of 205 patients receiving SGB for PTSD, we concluded that at least 4.4% did not respond to a right-sided SGB but did have a significant response to a left-sided SGB.

Impar ganglion block in patients with pelvic neuropathic pain: Three case Reports and surgical technique

Pelvic pain and coccydynia are discomfort and disabling symptoms for many patients. Assessment and treatment are individualized. Among several options available, the sacrococcygeal ganglion or impar (known as ganglion of Walther), a sensitive station of the pelvis, is one of the main therapeutic targets. Although knowledge about the nature and extent of the innervation pattern of this ganglion in the pelvic region has not been completely elucidated, neuromodulation techniques have been described as efficient treatment options for pelvic pain and coccydynia arising from acute and chronic conditions such as endometriosis, trauma, postsurgical interventions and also from idiopathic factors. The main techniques include chemical rhizotomy with steroids and anesthetics injections or radiofrequency (thermocoagulation). In this review, we report three cases, two with endometriosis and pelvic procedures and one with coccydynia from fracture, who underwent ganglion impar injection. At 6 months follow up, the VAS (Visual Analogue Scale) improvement achieved varied from 70-90%, demonstrating to be a safe, less invasive and efficient technique.

Anatomical-based percutaneous left stellate ganglion block in patients with drug-refractory electrical storm and structural heart disease: a single-centre case series.

The adoption of percutaneous stellate ganglion blockade for the treatment of drug-refractory electrical storm (ES) has been increasingly reported; however, the time of onset of the anti-arrhythmic effects, the safety of a purely anatomical approach in conscious patients and the additional benefit of repeated procedures remain unclear. This study included consecutive patients undergoing percutaneous left stellate ganglion blockade (PLSGB) in our centre for drug-refractory ES. Lidocaine, bupivacaine, or a combination of both were injected in the vicinity of the left stellate ganglion. Overall, 18 PLSGBs were performed in 11 patients (age 69 ± 13 years; 63.6% men, left ventricular ejection fraction 31.6 ± 16%). Seven patients received only one PLSGB; three underwent two procedures and one required three PLSGB and two continuous infusions to control ventricular arrhythmias (VAs). All PLSGBs were performed with an anatomical approach; lidocaine, alone, or in combination was used in 77.7% of the procedures. The median burden of VAs 1 h after each block was zero compared with five in the hour before (P < 0.001); 83% of the patients were free from VAs; the efficacy at 24 h increased with repeated blocks. The anti-arrhythmic efficacy of PLSGB was not related to anisocoria. No procedure-related complications were reported. Anatomical-based PLSGB is a safe and rapidly effective treatment for refractory ES; repeated blocks provide additional benefits. Percutaneous left stellate ganglion blockade should be considered for stabilizing patients to allow further ES management.

Retrospective evaluation of pain in patients with coccydynia who underwent impar ganglion block

BackgroundWe aimed to evaluate pain scores one year after impar ganglion block in patients with coccydynia who did not benefit from conservative treatment.MethodsThe medical records of 29 patients with coccydynia were reviewed. Patients who were referred to the algology clinic and underwent impar ganglion blocks were retrospectively evaluated. Demographic data, time to the onset of pain, causes of pain, X-ray findings, administered invasive procedures, and visual analog scale (pain) scores were recorded.ResultsA total of 29 patients were included in the study, 10 males (34%) and 19 females (66%). The average age and body mass index were 53.45 ± 9.6 and 29.55 ± 4.21 respectively. In 21 patients, the onset of pain was associated with trauma. Nineteen patients (65.5%) had anterior coccygeal angulation. The average visual analog scale score before undergoing an impar ganglion block was 7.4 ± 1. After the procedure, the scores at < 3 months, 3–6 months and 6 months-1 year follow-up intervals were significantly lower (p < 0.05). Furthermore, visual analog scale scores at the 3–6 months and 6 months-1 year periods were significantly lower in patients who received diagnostic blocks plus pulse radiofrequency thermocoagulation than in patients who underwent a diagnostic block only.ConclusionsThe impar ganglion block provides effective analgesia without complications in patients with coccydynia. Pulse radiofrequency thermocoagulation combined with a diagnostic block prolongs the analgesic effect of the procedure.

The Effect of Sphenopalatine Ganglion Block in Patients Undergoing Septorhinoplasty

The Effect of Sphenopalatine Ganglion Block in Patients Undergoing Septorhinoplasty