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Fajardo Pérez M, Yamak-Altinpulluk E, Díez Tafur R, Salazar-Zamorano CH, Espinosa Morales K, Oliver-Fornies P, Rocha-Romero A, Aguilar Ureña R, Juarez-Lemus A, Galluccio F, Abd-Elsayed A. Novel ultrasound-guided supraclavicular stellate ganglion block. Pain Pract 2024; 24:808-814. [PMID: 38251786 DOI: 10.1111/papr.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Stellate ganglion block (SGB) provides diagnostic and therapeutic benefits in pain syndromes in the head, neck, and upper extremity, including complex regional pain syndrome Types I and II, Raynaud's disease, hyperhidrosis, arterial embolism in the region of the arm. METHODS We present a novel ultrasound-guided supraclavicular stellate ganglion block. Considering the existing anatomical structures of the targeted area. RESULTS AND CONCLUSIONS We hope that we can provide fewer complications and additional benefits with this new approach.
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Affiliation(s)
- Mario Fajardo Pérez
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
| | - Ece Yamak-Altinpulluk
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
- Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Rodrigo Díez Tafur
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Centro MDRS - Sports, Spine & Pain Center: Lima Pain Institute, Lima, Peru
- Clínica Angloamericana British American Hospital, Lima, Peru
- Latin American Pain Society (LAPS), New York, New York, USA
| | - Carlos H Salazar-Zamorano
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Karla Espinosa Morales
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesia and Pain Medicine, Hospital de Trauma, Centro Integral de Salud de Puriscal, San José, Costa Rica
| | - Pablo Oliver-Fornies
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesiology, Critical Care and Pain Medicine, Móstoles University Hospital, Móstoles, Spain
- Aragon Institute for Health Research, Zaragoza, Spain
| | - Andrés Rocha-Romero
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesia and Pain Medicine, Hospital de Trauma, Centro Integral de Salud de Puriscal, San José, Costa Rica
- Department of Anesthesia and Pain Management, Centro Nacional de Rehabilitacion, Hospital de Trauma, San José, Costa Rica
| | - Ricardo Aguilar Ureña
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesiology, Critical Care and Pain Medicine, Centro Nacional de Rehabilitacion, San José, Costa Rica
| | - Angel Juarez-Lemus
- Department of Pain Medicine, National Cancer Institute, Mexico City, Mexico
| | - Felice Galluccio
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Fisiotech Lab Studio, Rheumatology and Pain Management, Firenze, Italy
- Center for Regional Anesthesia and Pain Medicine (CRAPM), Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Alaa Abd-Elsayed
- Anesthesiology Department, University of Wisconsin, Madison, Wisconsin, USA
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Franco-Riveros VB, Pividori SM, Martin TI, Nicora FE, Lallana MC, Pontecorvo AA, Flores JC, Tubbs RS, Boezaart AP, Reina MA, Buchholz B. Anatomical study with clinical significance of communicating and visceral branching of the cervical and upper thoracic sympathetic trunk. Clin Anat 2024. [PMID: 38469730 DOI: 10.1002/ca.24149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
Current advances in the management of the autonomic nervous system in various cardiovascular diseases, and in treatments for pain or sympathetic disturbances in the head, neck, or upper limbs, necessitate a thorough understanding of the anatomy of the cervicothoracic sympathetic trunk. Our objective was to enhance our understanding of the origin and distribution of communicating branches and visceral cervicothoracic sympathetic nerves in human fetuses. This was achieved through a comprehensive topographic systematization of the branching patterns observed in the cervical and upper thoracic ganglia, along with the distribution of communicating branches to each cervical spinal nerve. We conducted detailed sub-macroscopic dissections of the cervical and thoracic regions in 20 human fetuses (40 sides). The superior and cervicothoracic ganglia were identified as the cervical sympathetic ganglia that provided the most communicating branches on both sides. The middle and accessory cervical ganglia contributed the fewest branches, with no significant differences between the right and left sides. The cervicothoracic ganglion supplied sympathetic branches to the greatest number of spinal nerves, spanning from C5 to T2 . The distribution of communicating branches to spinal nerves was non-uniform. Notably, C3 , C4 , and C5 received the fewest branches, and more than half of the specimens showed no sympathetic connections. C1 and C2 received sympathetic connections exclusively from the superior ganglion. Spinal nerves that received more branches often did so from multiple ganglia. The vertebral nerve provided deep communicating branches primarily to C6 , with lesser contributions to C7 , C5 , and C8 . The vagus nerve stood out as the cranial nerve with the most direct sympathetic connections. The autonomic branching pattern and connections of the cervicothoracic sympathetic trunk are significantly variable in the fetus. A comprehensive understanding of the anatomy of the cervical and upper thoracic sympathetic trunk and its branches is valuable during autonomic interventions and neuromodulation. This knowledge is particularly relevant for addressing various autonomic cardiac diseases and for treating pain and vascular dysfunction in the head, neck, and upper limbs.
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Affiliation(s)
- Verena B Franco-Riveros
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
- School of Medicine, Department of Pathology, Institute of Cardiovascular Physiopathology (INFICA), Buenos Aires University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Institute of Biochemistry and Molecular Medicine (IBIMOL), Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Sofía M Pividori
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
- Diagnostic Imaging Department, Hospital Británico, Buenos Aires, Argentina
| | - Tomás I Martin
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - Florencia E Nicora
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - María Cecilia Lallana
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - Agustina A Pontecorvo
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
| | - Juan Carlos Flores
- Postgraduate Universitary Training at Interventional Procedures for Chronic Refractory Pain, CAIDBA Comprehensive Pain Center Foundation; and La Plata University School of Medical Sciences, La Plata, Buenos Aires, Argentina
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, West Indies
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - André P Boezaart
- Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- Lumina Health Pain Medicine Collaborative, Surrey, UK
| | - Miguel A Reina
- Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- School of Medicine, CEU-San-Pablo University, Madrid, Spain
- Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain
| | - Bruno Buchholz
- School of Medicine, Department of Human Anatomy, First Unit, Cardiovascular Anatomy Lab, Buenos Aires University, Buenos Aires, Argentina
- School of Medicine, Department of Pathology, Institute of Cardiovascular Physiopathology (INFICA), Buenos Aires University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Institute of Biochemistry and Molecular Medicine (IBIMOL), Buenos Aires University School of Medicine, Buenos Aires, Argentina
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Pei G, Meng S, Yang Y, Wang X, Liu Q, Wang S, Huang Y. Anatomical variations of the thoracic sympathetic ganglions and their effects on sympathicotomy for primary palmar hyperhidrosis. Clin Auton Res 2023; 33:111-120. [PMID: 37017809 PMCID: PMC10182923 DOI: 10.1007/s10286-023-00932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/13/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE The results and side effects of sympathicotomy for primary palmar hyperhidrosis (PPH) can vary due to anatomical variations of the sympathetic ganglions. The aim of our study was to clarify anatomical variations of the sympathetic ganglions by near-infrared (NIR) thoracoscopy and determine their effects on sympathicotomy for PPH. METHODS The cases of 695 consecutive patients with PPH treated with either R3 or R4 sympathicotomy either by normal thoracoscopy or by NIR fluorescent thoracoscopy between March 2015 and June 2021 were retrospectively reviewed and followed up. RESULTS The variation rate of third and fourth ganglions was 14.7% and 13.3% on the right side and 8.3% and 11.1% on the left side. Real T3 sympathicotomy (RTS3) was more effective than real T4 sympathicotomy (RTS4) in the short-term and long-term follow-up (p < 0.001 and p < 0.001, respectively). RTS3 was more satisfactory than RTS4 in the long-term follow-up (p = 0.03), but no significant difference was found in the short-term follow-up (p = 0.24). The incidence and severity of compensatory hyperhidrosis (CH) in the areas of the chest and back in the RTS4 group were significantly lower than those in the RTS3 group according to both the short-term results (12.92% vs. 26.19%, p < 0.001; 17.97% vs. 33.33%, p = 0.002, respectively) and the long-term results (19.66% vs. 28.57%, p = 0.017; 21.35% vs. 34.52%, p < 0.001, respectively). CONCLUSIONS RTS3 may be more effective than RTS4 for PPH. However, RTS4 appears to be associated with a lower incidence and severity of CH in the areas of the chest and back than RTS3. NIR intraoperative imaging of thoracic sympathetic ganglions may improve the quality of sympathicotomy surgeries.
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Affiliation(s)
- Guotian Pei
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Shushi Meng
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Yingshun Yang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Xiao Wang
- Shanxi Key Laboratory of Artificial Intelligence-Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Shanxi, China
| | - Qiang Liu
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Shuai Wang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Yuqing Huang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China.
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Peetermans M, Vanlommel J, Van Look L, Uyttebroek L, Van Schil P, van Nassauw L. The anatomical variations of the additional communicating rami in the proximal sympathetic trunk: A human cadaveric study. TRANSLATIONAL RESEARCH IN ANATOMY 2023. [DOI: 10.1016/j.tria.2023.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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Huang Y, Liu Y, Zou W, Mao N, Tang J, Jiang L, Zou G, Yang L, Yu B, Wei G. Impact of endoscopic thoracic R4 sympathicotomy combined with R3 ramicotomy for primary palmar hyperhidrosis. Front Surg 2023; 10:1144299. [PMID: 36911618 PMCID: PMC9998541 DOI: 10.3389/fsurg.2023.1144299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
Background Endoscopic thoracoscopic sympathectomy (ETS) is the preferred method for treating primary palmar hyperhidrosis (PPH) that bears the risk of compensatory hyperhidrosis (CH) following surgery. The current study aims to evaluate the effectiveness and safety of an innovative surgical procedure of ETS. Methods A survey of the clinical data of 109 patients with PPH who underwent ETS in our department from May 2018 to August 2021 was retrospectively conducted. The patients were organized into two groups. Group A underwent R4 sympathicotomy combined with R3 ramicotomy. Group B underwent R3 sympathicotomy. Patients were followed up to evaluate the safety, effectiveness and the incidence of postoperative CH of the modified surgical approach. Results A total of 102 patients completed follow-up, and seven of the total enrolled patients were lost to follow-up, with a loss rate of 6% (7/109). Among these, Group A constitutes 54 cases, group B constitutes 48 cases, and the mean follow-up was 14 months (interquartile range 12-23 months). There was no statistically difference in surgical safety, postoperative efficacy, and postoperative quality of life (QoL) score between group A and group B (p > 0.05). The score of the psychological assessment was higher (p = 0.004) in group A (14.15 ± 2.06) compared to group B (13.30 ± 1.86). The incidence of CH in group A was lower than in group B (p = 0.019). Conclusion R4 sympathicotomy combined with R3 ramicotomy is safe and effective for PPH treatment, along with a reduced incidence of postoperative CH rate and improved postoperative psychological satisfaction.
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Affiliation(s)
- Yunhe Huang
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunkun Liu
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Zou
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Na Mao
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jian Tang
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lei Jiang
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guowen Zou
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lun Yang
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bentong Yu
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guangxia Wei
- Department of Thoracic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
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