Use Of Stellate Ganglion Block Research Articles

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.

Use of Stellate Ganglion Block for Refractory Post-Traumatic Stress Disorder: A Review of Published Cases

Introduction: The lifetime prevalence of post-traumatic stress disorder (PTSD) is estimated to be 7.3% in the U.S. population, 10-20% among active duty service members and 35-40% among veterans. Overall success rates of evidence-based therapies for PTSD are low, leading clinicians to explore new therapeutic options. This study evaluated all published articles on the use of stellate ganglion block (SGB) as an adjunctive therapy for treatmentrefractory PTSD. Methods: EMBASE, PubMed, PsychINFO and Cochrane databases were searched using keyword combinations including stellate ganglion block, SGB, post-traumatic stress disorder, and PTSD. Articles were restricted to English language with no date delimiter. Twelve publications were identified, seven of which were eliminated due to lack of case data, duplicate patient sample, or descriptive reports with no standardized PTSD symptom assessment. Twenty-four cases from five articles were examined further by two independent evaluators who extracted data on sociodemographic and clinical characteristics including PTSD symptoms, comorbidities, and treatment history. Interrater reliability showed complete agreement (κ=1.0). Results: Cases were predominantly male (n=21, 88%) and active duty military (n=14, 58%) or veterans (n=8, 33%) with combat-related PTSD. The average age was 40.5 years (±10.0 SD). All cases had received >1 year of psychotherapy and pharmacotherapy before SGB. Seventeen cases (71%) received one SGB, seven (29%) received multiple SGBs. Clinically meaningful improvements were observed in 75% (n=18) of cases after SGB, with significant differences in mean PTSD scores pre- (69.5 ± 26.6) and post-SGB (34.2 ± 32.5) across cases (p<0.001). The effect size was relatively large (d=1.2). On average, PTSD improved by 50.4% (± 30.9 SD; range: 6.3-98.4) for cases with one SGB and 69.0% (± 28.0 SD; range: 9.2-93.5) for cases with multiple SGBs. Conclusions: Most patients with treatment-refractory PTSD experienced rapid improvement after SGB. Robust clinical trials are needed to determine SGB’s treatment efficacy for PTSD.

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.

The Use of Stellate Ganglion Block in the Treatment of Panic/Anxiety Symptoms with Combat‐Related Post‐Traumatic Stress Disorder; Preliminary Results of Long‐Term Follow‐Up: A Case Series

Report the successful use of stellate ganglion blocks (SGBs) in two patients experiencing symptoms of post-traumatic stress disorder (PTSD). Successful treatment of PTSD with SGB has been reported previously. A similar protocol was employed at Walter Reed Army Medical Center to treat two soldiers with chronic, combat-related PTSD. Both patients received a SGB on the right side at C6 level. The patients' PTSD symptoms were evaluated using the Post-traumatic Stress Disorder Checklist (PCL). The PCL was administered the day prior to treatment, to establish a baseline, and the day after treatment. The PCL was also utilized during follow-up visits to quantify the patient's symptomotology. The SGB was administered by an anesthesiologist and the psychometric tests administered by a psychologist. Both patients experienced immediate, significant and durable relief as measured by the PCL (score minimum 17, maximum 85). In both instances, the pre-treatment score suggested a PTSD diagnosis whereas the post-treatment scores did not. One patient requested repeat treatment after 3 months, and the post-treatment score remained below the PTSD cutoff after 7 additional months of follow-up. Both patients discontinued all antidepressant and antipsychotic medications while maintaining their improved PCL score. Selective blockade of the right stellate ganglion at C6 level is a safe and minimally invasive procedure that may provide durable relief from PTSD symptoms, allowing the safe discontinuation of psychiatric medications. blacksquare, square, filled.

Successful Use of Stellate Ganglion Block and Pulsed Radiofrequency in the Treatment of Posttraumatic Stress Disorder: A Case Report

Objective. To report our successful treatment of acute symptoms of posttraumatic stress disorder (PTSD). By the use of stellate ganglion block (SGB) and pulsed radiofrequency (PRF) to the stellate ganglion(SG) , sequentially. Background. A 48-year-old male a victim of armed robbery , who presented with extreme symptoms consistent with the diagnosis of PTSD. He was treated with antianxiety medications, as well as psychotherapy, but his symptoms persisted. Methods. Fifty-five days post trauma, we administered a SGB to the patient. One month later, we administered PRF to the right SG . We repeated the pulsed radiofrequency 30 weeks post trauma and performed a second SGB two weeks after that. Results. After the SGB , the patient experienced a major reduction in anxiety. Over the next week his improved allowing a significant reduction of antianxiety medications. One month later the symptoms returned and again subsided substantially following PRF , and that relief lasted four months. The patient than required another following PRF and a SGB with good responses. Conclusion. We report that selective blockade of the stellate ganglion via injection and the treatment with PRF, relieved our patient's symptoms of PTSD. And we also provide a plausible explanation of the effect.

Use of Stellate Ganglion Block to Salvage an Ischemic Hand Caused by the Extravasation of Vasopressors

This case report describes the successful use of early stellate ganglion block to salvage an acutely ischemic hand caused by the extravasation of vasopressors. A young man with a gunshot wound to the right inguinal area was brought to the operating room for surgical hemostasis and exploration. After discovery that the central line had been inserted in the proximity of the area of injury (right femoral vein), the vasopressor infusions were changed to a 14-gauge intravenous line inserted in the dorsum of the right hand. When the intravenous line became infiltrated, the hand was found to be swollen, cold, and underperfused. A right stellate ganglion block was immediately performed to overcome the intense peripheral vasoconstriction and, thus, re-establish circulation to the hand. Stellate ganglion block may prove to be an early measure in the treatment of upper-extremity ischemia caused by vasopressor extravasation.

Use of Stellate Ganglion Block to Salvage an Ischemic Hand Caused by the Extravasation of Vasopressors

Use of Stellate Ganglion Block to Salvage an Ischemic Hand Caused by the Extravasation of Vasopressors

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

Prolonged Horner's Syndrome following Stellate Ganglion Block -A case report-

Stellate ganglion block, due to its wide range of indications, is the most widely practiced procedure in pain clinics. We experienced the case of a 44-year-old female patient who developed prolonged Horner’s syndrome after the use of stellate ganglion block. The patient recovered spontaneously from the Horner’s syndrome after 12 months. If Horner’s syndrome should occur, its etiology will need to be assessed. It is also important to assure the patient they will recover from the complication within a year.

Preventing the Development of Complex Regional Pain Syndrome after Surgery

COMPLEX regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy (RSD), is used to describe a syndrome of pain and sudomotor or vasomotor instability. This pain syndrome usually has an initiating noxious event in the periphery, is not limited to the distribution of a single nerve, and is disproportionate to the inciting event. The Consensus Conference of the International Association for the Study of Pain has subclassified CRPS into two forms: CRPS I (formerly RSD) and CRPS II (formerly causalgia). According to the International Association for the Study of Pain, the diagnosis of CRPS I requires (1) continuing pain, allodynia, or hyperalgesia disproportionate to the injury; (2) evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain; and (3) no other conditions that would otherwise account for the degree of pain and dysfunction. Motor disturbances and trophic changes, such as altered nail and hair growth, may be observed in some cases. CRPS II is a pain syndrome that starts after a nerve injury and is not necessarily limited to the distribution of the injured nerve. The diagnostic criteria are the same as those of CRPS I. Patients with CRPS I or CRPS II can have sympathetically maintained pain or sympathetically independent pain. Sympathetically maintained pain, a term introduced in 1986 by Roberts, is pathologic pain that is supported by sympathetic efferent activity, circulating catecholamines, and/or increased sensitivity of -adrenergic receptors. Sympathetically maintained pain is identified by the ability to lessen the pain by sympatholytic blocks or interventions. Sympathetically independent pain has components of pain from sources other than sympathetic innervation and is believed to be most commonly observed in advanced cases of CRPS that do not respond to sympathetic blocks. Patients with CRPS may present with components of only sympathetically maintained pain or sympathetically independent pain or, more commonly, a combination of pain from each. Despite increasing research interest, little is known regarding which patients are at increased risk for development of postoperative CRPS and what the optimal perioperative treatment strategy is for those patients undergoing surgery who have a previous history of CRPS. This review outlines the surgical procedures that are believed to increase risk for development of CRPS and describes pharmacologic and regional analgesic techniques that may be of benefit for preventing the development of CRPS after surgery.

Use of Stellate Ganglion Blocks for Chronic Chest Pain Associated with Primary Pulmonary Hypertension

Use of Stellate Ganglion Blocks for Chronic Chest Pain Associated with Primary Pulmonary Hypertension

Use of Stellate Ganglion Blocks in the Treatment of Intractable Limb Pain in Lung Cancer

Over a 2-year period, six patients with lung cancer and severe, intractable upper extremity pain were evaluated for sympathetic dystrophy. Of these patients, three had symptoms and signs consistent with this diagnosis. All three of these patients obtained complete and long-lasting relief of pain after stellate ganglion block. This suggests that sympathetic dystrophy should be considered in the differential diagnosis of intractable extremity pain due to cancer.

11 The Use of Stellate Ganglion Block and Lumbar Sympathetic Block in Orthopaedics

11 The Use of Stellate Ganglion Block and Lumbar Sympathetic Block in Orthopaedics

Stellate ganglion block in cerebrovascular accidents.

Article1 August 1951STELLATE GANGLION BLOCK IN CEREBROVASCULAR ACCIDENTSWILLIAM A. NOSIK, M.D.WILLIAM A. NOSIK, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-35-2-409 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptNot until a relatively short time ago was interest rekindled in a more active treatment of cerebrovascular occlusions in the hope of decreasing the degree of neurologic residua. Stress had been placed upon the desirability of good nursing care and supportive attention. Drugs of the vasodilator group received but scant mention, there being little to suggest that any lasting benefit might result from a short period of vasodilatation.Since it appeared more logical to alter the cerebral blood supply directly in the treatment of various neurologic disorders, Royle1, 2suggested and performed thoracocervical sympathectomy in such conditions as early as...Bibliography1. Royle ND: Observations on the alteration of the circulation of the brain by surgical means in diseases of the central nervous system, Brit. M. J. 1 :1063-1068, 1932. CrossrefMedlineGoogle Scholar2. Royle ND: The surgical treatment of disseminated sclerosis, M. J. Australia 1: 586-588, 1933. CrossrefGoogle Scholar3. VillaretCachera MR: Les embolies cerebrales, 1939, Masson et Cie, Paris. Google Scholar4. MackeyScott WALD: Treatment of apoplexy by infiltration of the stellate ganglion with novocain, Brit. M. J. 2: 1, 1938. CrossrefMedlineGoogle Scholar5. VolpittoRisteen PWA: The use of stellate ganglion block in cerebral vascular occlusions, Anesthesiology 4: 403-408, 1943. CrossrefGoogle Scholar6. RisteenVolpitto WAP: Role of stellate ganglion block in certain neurologic disorders, South. M. J. 39: 431-434, 1946. CrossrefMedlineGoogle Scholar7. Gilbertde Takats NCG: Apoplexy, J. A. M. A. 136: 659-665, 1948. CrossrefMedlineGoogle Scholar8. ForbesCobb HSS: Vasomotor control of the cerebral vessels, in The Circulation of the Brain and Spinal Cord, Association for Research in Nervous and Mental Disease, Chapter 8, 1938, pages 201-215, Williams and Wilkins Company, Baltimore. CrossrefGoogle Scholar9. de Sousa Pereira A: Blocking of middle cervical and stellate ganglions with descending infiltration anesthesia; technic, accidents and therapeutic indications, Arch. Surg. 50: 152-165, 1945. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Cleveland, Ohio*Presented before the Section of Medicine, Cleveland Academy of Medicine, November 10, 1948, and the Tri-State Neurological Meeting, September 24, 1949.Received for publication December 12, 1949. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byStellate ganglion block—therapy for cerebral vascular accidentsThe Treatment of Cerebrovascular AccidentO bloqueio do gânglio estrelado nas tromboses e embolias cerebrais agudas 1 August 1951Volume 35, Issue 2Page: 409-416KeywordsBloodDrugsStrokeSympathectomyVasodilationVasodilators ePublished: 1 December 2008 Issue Published: 1 August 1951 PDF downloadLoading ...