Unexpected beneficial effect of stellate ganglion block in a schizophrenic patient

Stellate Ganglion Block for Psychiatric Disorders: A Systematic Review of the Clinical Research Landscape

Stellate ganglion block (SGB) is a procedure involving the injection of a local anesthetic surrounding the stellate ganglion to inhibit sympathetic outflow. The objective of this review was to summarize existing evidence on the use of SGB in adults with psychiatric disorders. A systematic search identified 17 published studies and 4 registered clinical trials. Eighty-eight percent of published studies, including 2 randomized controlled trials (RCTs), used SGB for posttraumatic stress disorder (PTSD), although its use for schizophrenia spectrum disorders was also explored. Administration of 1 to 2 SGBs using right-sided laterality with 0.5% ropivacaine was most common. Preliminary evidence from clinical trials and case studies supports the feasibility of SGB for treating psychiatric disorders involving dysregulation of the sympathetic nervous system, although effectiveness evidence from RCTs is mixed. One RCT concluded that improvement in PTSD symptoms was significant, while the other concluded that it was nonsignificant. Improvements were noted within 5 minutes of SGB and lasted 1 month or longer. Registered clinical trials are exploring the use of SGB in new psychiatric disorders, including major depressive disorder and borderline personality disorder. More studies with larger sample sizes and alternate protocols are needed to further explore therapeutic potential of SGB for psychiatric disorders.

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.

Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography

BACKGROUND

Stellate ganglion block (SGB) causes vasodilatation in the skin of the head and neck because of regional sympathetic block. Its effects on cerebral haemodynamics, in health or in disease, are not clear. We evaluated the effects of SGB on ipsilateral middle cerebral artery flow velocity (MCAFV), estimated cerebral perfusion pressure (eCPP), zero flow pressure (ZFP), carbon dioxide reactivity (CO2R) and cerebral autoregulation using transcranial Doppler ultrasonography (TCD).

METHODS

Twenty male patients, with pre-existing brachial plexus injury, and undergoing SGB for the treatment of complex regional pain syndrome of the upper limb, were studied. For SGB, 10 ml of plain lidocaine 2% was used and the onset of block was confirmed by presence of ipsilateral Horner's syndrome. The MCAFV, eCPP, ZFP, CO2R, and cerebral autoregulation were assessed before and after SGB using established TCD methods. The changes in these variables were analysed using Wilcoxon's signed rank test.

RESULTS

The block caused a significant decrease in MCAFV from median (inter-quartile range) value of 61 (53, 67) to 55 (46, 60) cm s(-1), a significant increase in eCPP from 59 (51, 67) to 70 (60, 78) mm Hg, and a significant decrease in ZFP from 32 (26, 39) to 25 (16, 30) mm Hg. There were no significant changes in CO2R or cerebral autoregulation.

CONCLUSION

The increase in eCPP, decrease in ZFP, and no changes in CO2R or cerebral autoregulation suggest that the SGB decreases cerebral vascular tone without affecting the capacity of the vessels to autoregulate. These effects may be of therapeutic advantage in relieving cerebral vasospasm in certain clinical settings.