Ultrasound-guided Stellate Ganglion Block Research Articles

The Successful Use of Bilateral 2-Level Ultrasound-Guided Stellate Ganglion Block to Improve Traumatic Brain Injury Symptoms: A Retrospective Analysis of 23 Patients.

The purpose of the study was to determine whether performing ultrasound-guided, bilateral stellate ganglion blocks (SGBs; performed on subsequent days) improved traumatic brain injury (TBI) symptoms. A retrospective chart review was conducted for the time period between August 2022 and February 2023 to identify patients who received bilateral, 2-level (C6 and C4) SGBs for PTSD symptoms but who also had a history of TBI. Neurobehavioral Symptoms Inventory (NSI) scores were collected at baseline, 1 week, and 1 month post-treatment in 14 males and 9 females. Out of 23 patients, 22 showed improvement in their NSI scores. NSI baseline average score was 42.7; the average score at 1 week post-treatment was 18.8; 1 month post-treatment was 20.1. This represents a 53% improvement in the NSI score between baseline and 1 month. The use of bilateral, 2-level SGBs may be indicated in treating patients with PTSD symptoms with concomitant diagnoses of mild-to-moderate TBI.

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.

Ultrasound-guided Stellate Ganglion Block for Upper Extremity Phantom Limb Pain - A Case Series

Abstract Background: Stellate ganglion block (SGB) is effectively utilized in various sympathetically mediated pain conditions of head and neck, upper limb such as complex regional pain syndrome, postherpetic neuralgias, but there has been a paucity of evidence of SGB for the management of phantom limb pain (PLP). Methods: Ten upper extremity PLP patients underwent ultrasound-guided SGB block. Under real-time needle tip visualization and after ensuring negative aspiration, 5 mL of 1% lignocaine and 4 mg of dexamethasone were injected. Postprocedure pain score (numerical rating scale [NRS]) and patient satisfaction score (Likert scale) were noted, and patients were followed-up for the next 60 days. Results: The baseline NRS score (Mean [standard deviation]) of 7.8 (0.748) showed significant reduction (P < 0.001) to 2.8 (0.748) at immediate postinjection, to 2.6 (0.663) at day 7, at day 30 (2.9 [0.7]), and at day 60 (30.775). Most of the patients (80%–90%) were somewhat to very much satisfied with the treatment response (score 4–5 on Likert scale) at all the follow-up intervals. Only mild and transient adverse events were demonstrated in two patients who developed hoarseness of voice. Conclusion: Ultrasound-guided SGB effectively reduces pain and improves patient satisfaction in postamputee patients who developed PLP, over 2 months of the follow-up period. Further prospective randomized controlled trials over a larger duration with more sample size are needed to provide more concrete evidence.

Prospective study on ultrasound-guided stellate ganglion block improves cerebral blood flow in patients with stroke

ObjectivesThe effect of routine internal medicine and stroke rehabilitation treatment was not good. To confirm that ultrasound-guided stellate ganglion block (SGB) can improve cerebral blood flow in patients with stroke, Transcranial Doppler (TCD) and carotid ultrasound were used to monitor the cerebral blood flow parameters of ultrasound-guided SGB in patients with stroke. MethodsA prospective study of 40 patients with stroke from January 2021 to October 2022 randomly divided into two groups (group SGB: undergoing ultrasound-guided SGB and standard medical procedures, control group: undergoing standard medical procedures) with 20 cases in each was conducted in People's Hospital of Chongqing Liang Jiang New Area. TCD and carotid artery ultrasound were monitored before and after treatment. There were no significant differences in general data on age, gender, disease course, and stroke type between two groups (P>0.05). ResultsAfter treatment, the bilateral ACA Vm of group SGB was significantly higher, the bilateral internal carotid artery RI and left VA RI were significantly lower than in control group (P<0.05). In group SGB, the Vm of bilateral MCA, bilateral PCA, right ACA, bilateral VA, and BA after treatment were significantly (P<0.05) increased compared to before treatment. PI of bilateral MCA, right ACA, and left VA after treatment were significantly (P<0.05) decreased compared to before treatment. RI of bilateral MCA, bilateral PCA, and bilateral VA after treatment were significantly (P<0.05) decreased compared to before treatment. Right internal carotid artery D after treatment was significantly (P<0.05) higher than before treatment. RI of bilateral internal carotid artery after treatment was significantly (P<0.05) lower than before treatment. ConclusionsUltrasound-guided stellate ganglion block could improve local cerebral blood flow and vascular compliance in patients with stroke, and reduce vascular resistance.

Effect of ultrasound-guided stellate ganglion block on inflammatory cytokines and postoperative recovery after partial hepatectomy: a randomised clinical trial

BackgroundStellate ganglion block (SGB) has been shown to reduce perioperative complications in various surgeries. Because laparoscopic techniques and instruments have advanced during the past two decades, laparoscopic liver resection is being increasingly adopted worldwide. Lesser blood loss, fewer postoperative complications, and shorter postoperative hospital stays are the advantages of laparoscopic liver resection, as compared to conventional open surgery. There is an urgent need for an effective intervention to reduce perioperative complications and accelerate postoperative recovery. This study investigated the effect of ultrasound-guided SGB on enhanced recovery after laparoscopic partial hepatectomy.MethodsWe compared patients who received SGB with 0.5% ropivacaine (group S) with those who received SGB with 0.9% saline (group N). A total of 58 patients with partial hepatectomy were enrolled (30 S) and (28 N). Before induction of anesthesia, SGB was performed with 0.5% ropivacaine in group S and 0.9% saline in group N. Main outcome: Comparison of serum inflammatory cytokines concentration at each time point.ResultsMain outcome: When comparing IL-6 and IL-10 concentrations among groups, group S showed less variation over time compared to group N. For comparison between groups, the serum IL-6 concentration in group S was lower than that in group N at 6 and 24 h after operation (P < 0.01), and there was a significant linear relationship between serum IL-6 concentration at 24 h after operation and hospitalization situation.ConclusionsUltrasound-guided SGB can stabilize perioperative inflammatory cytokines plays a positive role in the enhanced recovery of patients after laparoscopic partial hepatectomy. The serum IL-6 level within 24 h after surgery may be used as a predictor of hospitalization.Trial registrationThe study was registered at the ClinicalTrials.gov (Registration date: 13/09/2021; Trial ID: NCT05042583).

Effect of ultrasound-guided stellate ganglion block on lung protection for patients undergoing one-lung ventilation.

To explore the potential effect of ultrasound-guided stellate ganglion block (SGB) on lung protection for patients undergoing one-lung ventilation (OLV). A total of 123 patients undergoing elective one-lung ventilation surgery were selected as research subjects in this prospective study. These patients were randomly divided into the SGB group, control group and blank group on average. Stellate ganglion block was carried out in the SGB and control groups. Patients in the SGB group were injected with 6 ml mixture of 0.25% ropivacaine hydrochloride and 1% lidocaine hydrochloride, while those in the control group were injected with 6 mL of 0.9% saline. Punctures weren't performed for patients in the blank group. The same induction and maintenance of general anesthesia was adopted for all three groups. Hemodynamics, respiratory parameters and arterial blood gas analysis were recorded after entering the operation room (T0), pre-OLV (T1), 30 min after OLV (T2), 60 min after OLV (T3), at the end of surgery (T4), and 30 min after extubation (T5). Oxygenation index (OI), pulmonary shunt fraction (Qs/Qt) and pH value were compared at different time points. Intravenous serum was collected at T0, T3 and T5 for the detection of surfactant proteins A (SP-A), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-6 (IL-6) and interleukin-10 (IL-10) levels, respectively. The complications related to SGB after surgery and the postoperative pulmonary complications within 72 h were recorded. At T1, T2, and T3, MAP level in SGB group was lower than that in blank and control groups (P<0.05). At T2, and T3, SGB group had lower hear rate (HR), peak airway pressure (Ppeak) and tidal volume (TV) than blank and control groups (all P<0.05). From T2 to T5, SGB group had higher OI but lower Qs/Qt than blank and control groups (both P<0.05). At T3 and T5, SGB group had lower SP-A, IL-6, and MDA levels but higher IL-10 and SOD levels than blank and control groups (all P<0.05). There was one case of hypoxemia in the blank group within 72 h after surgery. Ultrasound-guided SGB has lung-protective effects on patients undergoing OLV, which significantly improves patients' OI, reduces intrapulmonary shunts, declines ventilator-induced lung damage, and inhibits inflammatory response as well as oxidative stress (China Clinical Trial Registry, registration number ChiCTR2000033385, https://www.chictr.org.cn).

Observation of the Therapeutic Effect of Ultrasound-Guided Stellate Ganglion Block on Sleep Disorders in Patients Recovered from COVID-19

Observation of the Therapeutic Effect of Ultrasound-Guided Stellate Ganglion Block on Sleep Disorders in Patients Recovered from COVID-19

Bloqueo del ganglio estrellado como tratamiento de la tormenta arrítmica: estudio observacional

IntroductionArrhythmic storm is a life-threatening emergency with a high mortality rate. When acute conventional treatment is ineffective, a stellate ganglion block can contribute to the control of the arrhythmia by providing a visceral cervicothoracic sympathetic block. The objective of the study is to assess the effectiveness and safety of stellate ganglion blocks for the treatment of refractory arrhythmic storm. MethodFollow-up of a cohort of patients with refractory arrhythmic storm that met the criteria for performing stellate ganglion blocks. The block was ultrasound-guided at C6-level using local anaesthetic and a steroid, left unilateral first, bilateral if no response, and followed by fluoroscopy-guided radiofrequency ablation at C7 if there was a favourable response but subsequent relapse. ResultsSeven patients were included, with a mortality rate during admission of 14.29%. Four patients received unilateral and three bilateral stellate ganglion blocks. Six were ablated and one of them had an implanted cardioverter-defibrillator. Arrhythmic storm was controlled temporarily beyond the effect of the local anaesthetic in all patients. Three underwent radiofrequency ablation and two underwent surgical thoracic sympathectomy. The only side effect was Horner's syndrome, which was observed in all cases after administering a stellate ganglion block with local anaesthetic. Two died after discharge and four are still at home, three of them without further admission due to ventricular events for more than two years. ConclusionAn ultrasound-guided stellate ganglion block is an effective and safe technique in the treatment of refractory arrhythmic storm as a complement to the usual cardiological treatment.

Effects of ultrasound-guided stellate ganglion block on postoperative sore throat and postoperative sleep disturbance after lumbar spine surgery: a randomized controlled trial

BackgroundPostoperative sore throat and sleep disturbance are prevalent among patients undergoing spinal surgery, and these conditions can substantially impact their postoperative satisfaction and quality of life. The present study aimed to examine the impact of ultrasound-guided stellate ganglion block (SGB) on the occurrence of postoperative sore throat (POST) and postoperative sleep disturbance (PSD) in patients who undergo lumbar spine surgery under general anesthesia.MethodsSixty patients were randomly assigned to either the experimental group (SGB group) or the control group (CG). Both groups received the same induction and maintenance drugs. However, the SGB group received a right SGB under ultrasound guidance 15 min before anesthesia induction, while the CG did not receive any block anesthesia intervention before anesthesia induction. We monitored the incidence and severity of POST at 1, 6, 24, and 48 h after surgery in both groups. Additionally, we evaluated the deep sleep quality score on the first, second, and fifth days after surgery in both groups.ResultsThe incidence of POST at 1 h and 6 h after surgery was significantly lower in the SGB group (10.0% and 13.3%) than in the CG (43.3% and 36.7%) (P < 0.05). The postoperative sore throat scores of the SGB group (0.10 ± 0.31 and 0.17 ± 0.46) at 1 h and 6 h after surgery were lower than those of the CG (0.57 ± 0.73 and 0.50 ± 0.77) (P < 0.05). Moreover, the deep sleep quality score on the first, second, and fifth days after surgery were significantly higher in the CG (5.40 ± 3.37, 4.70 ± 3.19, 4.53 ± 3.44) than in the SGB group (3.87 ± 2.30, 3.13 ± 1.77, 3.03 ± 1.84) (P < 0.05).ConclusionUltrasound-guided SGB can reduce the incidence and severity of POST and improve PSD in patients undergoing lumbar spine surgery.Trial registrationThis study was registered on Chinese Clinical Trial Registry, (ChiCTR2200065279) on 01/11/2022.

Clinical efficacy of ultrasound-guided stellate ganglion block combined with extracorporeal shock wave therapy on limb spasticity in patients with ischemic stroke

IntroductionTo observe the clinical efficacy of ultrasound-guided stellate ganglion block (SGB) + extracorporeal shock wave therapy (ESWT) for limb spasticity in patients with ischemic stroke.MethodsA total of 60 patients with post-stroke limb spasticity in our hospital were selected and randomly divided into four groups (n = 15). In the control group, patients received routine rehabilitation training. Based on routine rehabilitation training, SGB group patients underwent ultrasound-guided SGB, ESWT group patients received ESWT, and SGB + ESWT group patients received ultrasound-guided SGB combined with ESWT. The total treatment course was one month. The Modified Barthel Index (MBI) score, Fugl-Meyer Assessment and upper limb rehabilitation training system were applied to evaluate the activities of daily living, upper limb motor function and upper limb performance before and after treatment. Finally, the improvement after treatment was compared among different groups.ResultsAfter treatment, compared with the control group, the MBI score and the upper limb score based on Fugl-Meyer Assessment in the SGB, ESWT, and SGB + ESWT groups were significantly increased (P < 0.05). Furthermore, compared with the SGB and ESWT groups, SGB + ESWT exhibited a higher upper limb function score (P < 0.05), while the MBI score was not significantly different (P > 0.05). In terms of upper limb performance ability, patients in the SGB, ESWT and SGB + ESWT groups had better fitting degree, participation and exertion of exercise than those in the control group, and the SGB + ESWT group patients had the same movement trajectory as robots.ConclusionUltrasound-guided SGB and ESWT can reduce the muscle tension of patients, alleviate spasticity, promote the motor function of the upper limb, and improve the working performance of patients. However, the effect of SGB combined with ESWT is better.

Stellate ganglion block for the management of electrical storm: An observational study

IntroductionElectrical storm is a life-threatening emergency with a high mortality rate. When acute conventional treatment is ineffective, stellate ganglion block can help control arrhythmia by providing a visceral cervicothoracic sympathetic block. The objective of this study is to assess the effectiveness and safety of stellate ganglion block in the management of refractory arrhythmic storm. MethodFollow-up of a cohort of patients with refractory electrical storm that met the criteria for performing stellate ganglion block. The block was ultrasound-guided at C6 using local anaesthetic and a steroid – left unilateral first, bilateral if no response, followed by fluoroscopy-guided radiofrequency ablation at C7 if there was a favourable response but subsequent relapse. ResultsSeven patients were included. The in-hospital mortality rate was 14.29%. Four patients received unilateral and 3 bilateral stellate ganglion block. Six were ablated and 1 received an implantable cardioverter-defibrillator. Electrical storm was controlled temporarily beyond the effect of the local anaesthetic in all patients. Three patients underwent radiofrequency ablation and 2 underwent surgical thoracic sympathectomy. The only side effect was Horner’s syndrome, which was observed in all cases after administering a stellate ganglion block with local anaesthetic. Two patients died after discharge and 4 are alive at the time of writing, 3 of them have not been re-admitted for ventricular events for more than 2 years. ConclusionUltrasound-guided stellate ganglion block is an effective and safe complement to standard cardiological treatment of refractory electrical storm.

Retracted: Effects of the Ultrasound-Guided Stellate Ganglion Block on Hemodynamics, Stress Response, and Gastrointestinal Function in Postoperative Patients with Colorectal Cancer.

[This retracts the article DOI: 10.1155/2022/2056969.].

Clinical Efficacy Evaluation of Ultrasound-Guided C2 Dorsal Root Nerve Pulsed Radiofrequency Combined with Stellate Ganglion Block in the Treatment of Cervicogenic Headache: A Retrospective Cohort Study.

To explore the therapeutic effect of C2 dorsal root ganglion pulsed radiofrequency (PRF) combined with stellate ganglion block (SGB) in patients with cervicogenic headache (CEH). We retrospectively reviewed 90 patients diagnosed with CEH who were admitted to our hospital between May 2019 and May 2022. All patients were divided into three groups (n = 30 each) according to the actual treatment method used: ultrasound-guided SGB, ultrasound-guided C2 dorsal root ganglion PRF treatment, and ultrasound-guided C2 dorsal root ganglion PRF combined with SGB treatment. Patients' pain intensity, sleep, and mood changes were assessed by statistically analyzing their pain visual analog scale (VAS), Pittsburgh Sleep Quality Inventory (PSQI), and short-form McGill Pain Questionnaire affective item scores before and after treatment. The post-treatment VAS, PSQI, and McGill scores were significantly decreased in all patients (P < 0.05), and all three scores in ultrasound-guided C2 dorsal root ganglion PRF combined with SGB were lower than those in ultrasound-guided SGB alone and ultrasound-guided C2 dorsal root ganglion PRF alone (P < 0.05). The use of ultrasound-guided C2 dorsal root ganglion PRF combined with SGB in patients with CHE is effective in alleviating pain and improving sleep, and deserves to be replicated in the clinic.

Greater occipital nerve acupotomy combined with ultrasound-guided stellate ganglion block in the treatment of a case of cervicogenic headache.

Greater occipital nerve acupotomy combined with ultrasound-guided stellate ganglion block in the treatment of a case of cervicogenic headache.

Effectiveness of ultrasound-guided stellate ganglion block in a patient with Dejerine-Roussy syndrome

Dejerine-Roussy syndrome or Central Post-Stroke Pain (CPSP) is one of the most debilitating complications of cerebrovascular accidents. Sympathetic block such as stellate ganglion block (SGB) is one of the modalities used for this condition. Ultrasound guidance provides advantages for these procedures by increasing accuracy and practicality with lower exposure to radiation. A 43-year-old man came to our clinic with chronic pain which started nine years earlier after an episode of hemorrhagic stroke. The pain was refractory to analgesics, which were prescribed by healthcare facilities he visited. Further examination revealed a burning sensation and allodynia on the left side of his body. We then proceeded to perform ultrasound-guided SGB using 8 ml of 1% lidocaine along with dexamethasone 5 mg as an adjuvant agent. After two procedures within two months, SGB decreased the patient’s pain by 50−85%. Ultrasound-guided stellate ganglion appears to be safe and effective as a treatment for Dejerine-Roussy syndrome.&#x0D; Abbreviations: CPSP: Central Post-Stroke Pain; IPM: Interventional Pain Management; NRS: Numeric Rating Scale; SGP: Stellate Ganglion Block&#x0D; Key words: Case report, Dejerine-Roussy syndrome, Pain, Stellate ganglion block, Ultrasound&#x0D; Citation: Novy TCT. Effectiveness of ultrasound-guided stellate ganglion block in a patient with Dejerine-Roussy syndrome. Anaesth. pain intensive care 2023;27(3):441−343; DOI: 10.35975/apic.v27i3.2165&#x0D; Received: March 08, 2023; Reviewed: April 15, 2023; Accepted: April 20, 2023

Ultrasound-guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study.

This study aimed to assess the effectiveness and safety of ultrasound-guided stellate ganglion block (SGB) in the prophylactic treatment of migraine in the elderly. Treatment of migraine in the elderly is often difficult and troublesome due to multiple comorbidities, drug interactions, and adverse effects (AEs). SGB may be an effective treatment approach for migraine in the elderly as its clinical use is rarely limited by concomitant diseases and age-related physiological changes; however, no studies have evaluated the effectiveness of SGB in the treatment of migraine in the elderly population. This is a retrospective observational case series study. We retrospectively analyzed patients with migraine aged ≥65 years, who underwent ultrasound-guided SGB for headache management between January 2018 and November 2022. Pain intensity using the numerical rating scale (NRS, 0-10), number of days with headache per month, duration of headache, and the consumptions of acute medications were recorded before SGB treatment, and at 1, 2, and 3 months after the last SGB. Safety assessment included thorough documentation of serious and minor AEs related to SGB. Of 71 patients, 52 were analyzed in this study. After the final SGB, the NRS scores decreased significantly from a mean (± standard deviation [SD]) of 7.3 (1.2) at baseline to 3.3 (1.4), 3.1 (1.6), and 3.6 (1.6) at 1, 2, and 3 months, respectively (vs. baseline, p < 0.001). The mean (SD) number of headache days per month significantly reduced from 23.1 (5.5) to 10.9 (7.1) (p < 0.001), 12.7 (6.5) (p = 0.001), and 14.0 (6.8) days (p = 0.001) at the 1-, 2-, and 3-month follow-ups, respectively. The values of headache duration were also significantly lower at the 1-month (mean [SD] 12.5 [15.8] h, p = 0.001), 2-month (mean [SD] 11.3 [15.9] h, p = 0.001), and 3-month follow-ups (mean [SD] 14.3 [16.0] h, p = 0.001) compared to pre-treatment baseline (mean [SD] 22.7 [17.1] h). There were 33/52 (64%) patients experiencing at least a 50% reduction in acute medications consumption 3 months after the final SGB treatment. The overall AEs rate associated with ultrasound-guided SGB was 9.0% (26/290 SGBs). There were no serious AEs; all reported AEs were minor and transient. Stellate ganglion block treatment could reduce pain intensity, headache frequency, and duration of migraine, thereby reducing the need for adjunctive medications in elderly patients. Ultrasound-guided SGB might be a safe and effective intervention for the treatment of migraine in elderly patients.

Treatment of stellate ganglion block in diseases: Its role and application prospect

The stellate ganglion (SG), as a type of sympathetic ganglion, consists of the sixth and seventh cervical vertebrae and the first thoracic sympathetic ganglia. SG block (SGB) is a minimally invasive injection that aims to inject low-concentration local anesthetics to induce a broad sympathetic blocking effect near the SG. There have been no changes and progress in the clinical application of SGB since the 1830s due to several potential risks, including hematoma from blood vessel injury, hoarseness from recurrent laryngeal nerve injury, and cardiopulmonary arrest. The feasibility and safety of SGB have greatly improved since the appearance of ultrasound-guided SGB. In recent years, SGB has been widely applied in the field of non-anesthesiology sedation, with significant therapeutic effects on pain, immunological diseases, somnipathy, psychological disorders, arrhythmias, and endocrine diseases. The present study reviews the present application of SGB in clinical practice.

Successful Management of Unilateral Post-traumatic Neuropathic Mastalgia: A Case Report.

Stellate ganglion block has been described in the management of postmastectomy neuropathic pain. However, its role in the treatment of posttraumatic neuropathic breast pain has not been reported in the literature. We present a case of a 40-year-old female with a chief complaint of severe debilitating pain in her right breast following trauma, refractory to oral medications including conventional analgesics, amitriptyline, pregabalin, and duloxetine. She was successfully managed after administration of ultrasound-guided stellate ganglion block and pulsed radiofrequency ablation of the stellate ganglion. It resulted in significant and prolonged pain relief leading to improved quality of life.

Stellate Ganglion Block Improves Postoperative Sleep Quality and Analgesia in Patients with Breast Cancer: A Randomized Controlled Trial.

Postoperative impaired sleep quality and pain are associated with adverse outcomes. Stellate ganglion block (SGB) has shown promising results in enhancing sleep quality and alleviating neuropathic pain. This study aimed to investigate the effects of ultrasound-guided SGB on postoperative sleep quality and pain in patients undergoing breast cancer surgery. This study is a parallel-group randomized controlled clinical trial with two groups: SGB and control. Fifty female patients undergoing breast cancer surgery were randomized in a 1:1 ratio to receive preoperative ultrasound-guided single-injection SGB (SGB group) or just an ultrasound scan (control group). All participants were blinded to the group assignment. The primary outcome was postoperative sleep quality, assessed by the St. Mary's Hospital Sleep Questionnaire and actigraphy 2days postoperatively. The secondary outcome was postoperative pain, measured by thevisual analog scale. A total of 48 patients completed the study, with 23 patients in the control group and 25 in the SGB group. The postoperative St. Mary's Hospital Sleep Questionnaire scores were significantly higher in the SGB group than in the control group on 1day postoperative (30.88 ± 2.44 versus 27.35 ± 4.12 points, P = 0.001). The SGB also increased the total sleep time and sleep efficiency (main actigraphy indicators) during the first two postoperative nights. Compared with the control group, preoperative SGB reduced postoperative pain and the incidence of breast cancer-related lymphedema (20% versus 52.2%, P = 0.02, odds ratio 0.229, 95% confidence interval 0.064-0.821). There were no adverse events related to SGB. Preoperative ultrasound-guided SGB improves postoperative sleep quality and analgesia in patients undergoing breast cancer surgery. SGB may be a safe and practical treatment to enhance the postoperative quality of life in patients with breast cancer. The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100046620, principal investigator: Kai Zeng, date of registration: 23 May 2021).

Establishment of ultrasound-guided stellate ganglion block in rats.

A novel protocol for accurate stellate ganglion block under ultrasound guidance was designed in rats. This technique raises the success rate of stellate ganglion block and reduces the incidence of brachial plexus and vagus nerve block. Fifty-six Sprague-Dawley were randomly divided into an ultrasound-guided group (n = 28) and a blind technique group (n = 28). The rats in the blind technique group were injected with 1.5% lidocaine mixed with methylene blue after signs of brachial plexus stimulation were elicited. The lateral side of the cephalic brachial vein was located under the first rib, where lidocaine was injected into the rats in the ultrasound-guided group. The up-and-down sequential method of Dixon was used to determine the minimum effective volume for stellate ganglion block in rats. Furthermore, we calculated the required operative duration of the two methods and observed the difference in the lidocaine diffusion range between the two groups. The minimum effective volume for stellate ganglion block in the ultrasound-guided group was 0.040 ml, and the 95% CI was 0.026-0.052 ml. In the blind technique group, the minimum effective volume was 0.639 ml, and the 95% CI was 0.490-0.733 ml. Within the 95% CI of the lowest effective volume, the incidence of brachial plexus block as a complication of stellate ganglion block under ultrasound guidance was 10.00%. Stellate ganglion block under ultrasound guidance is more accurate than blind detection, which the incidence of complications of stellate ganglion block under ultrasound guidance was significantly lower than under blind detection; the rate of methylene blue staining in the vagus nerve was significantly lower under ultrasound guidance.