Avoiding intravascular injection during ultrasound-guided stellate ganglion block

Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound

Objective

This study aimed to investigate the effects of stellate ganglion block (SGB) through different approaches under guidance of ultrasound.

Methods

A total of 130 patients undergoing SGB in our hospital between February 2019 and February 2020 were enrolled as the research subjects. According to the random number table method, these subjects were divided into two groups: a modified 6th cervical vertebra (C6) group (n = 65) and a 7th cervical vertebra (C7) group (n = 65). Under the guidance of ultrasound, the subjects in the modified C6 group were punctured at the level of the C6 transverse process, and the subjects in the C7 group were punctured at the level of the C7 transverse process. The operation duration, number of puncture angle adjustments, block effects, and adverse reactions for SGB were compared between the two groups.

Results

The modified C6 group showed shorter SGB operation duration and a lower number of puncture angle adjustments than the C7 group, and the differences were statistically significant (P < 0.05). Horner Syndrome occurred in both groups after SGB. The incidence of adverse reactions in the modified C6 group was 4.62%, comprising 1 case of hoarseness and 2 cases of slowed pulse, while that in the C7 group was 6.15%, with 1 case of hoarseness and 3 cases of slowed pulse; the difference between the two groups was not statistically significant (P > 0.05).

Conclusion

The operation duration for modified SGB guided by ultrasound puncturing at the C6 transverse process is shorter and requires fewer puncture angle adjustments than puncturing at the C7 transverse process; however, there is no significant difference between the incidence of adverse reactions or the blocking effects of the two methods.

Ultrasound-guided Stellate Ganglion Block Improves Gastrointestinal Function After Thoracolumbar Spinal Surgery

PURPOSE

The purpose of this study was to investigate the effects of stellate ganglion block (SGB) on gastrointestinal function after thoracolumbar spinal surgery.

METHODS

Forty patients with thoracolumbar fracture scheduled for posterior spinal surgery were randomly assigned to 2 groups: ultrasound-guided SGB or sham (control group). After induction, ultrasound-guided SGB (n = 20) or a sham procedure (n = 20) was conducted with a 6-mL injection of 1% lidocaine or 0.9% saline, respectively. Primary outcomes were postoperative gastrointestinal function, including auscultation of bowel sounds, incidence and degree of abdominal bloating, flatus time, and paralytic ileus.

FINDINGS

Patients in the SGB group had better gastrointestinal function compared with those in the sham (control) group, as indicated by more regular bowel sounds at 24 and 36 hours postoperatively (80% vs 40%, P = 0.024, and 95% vs 60%, P = 0.023), lesser abdominal bloating (10% vs 45%, P = 0.034), and slightly shorter flatus time (mean [SD], 12.0 [4.4] vs 14.7 [4.6] hours, P = 0.068). Survival analysis based on regular bowel sounds found a significant difference between the 2 groups (P = 0.004). In addition, more patients had higher satisfaction after SGB (85% vs 45%, P = 0.020). No postoperative ileus or mortality occurred.

IMPLICATIONS

In this preliminary study, ultrasound-guided SGB accelerated the return of gastrointestinal transit, alleviated bowel symptoms, and improved patient satisfaction after thoracolumbar spinal surgery. chictr.org.cn identifier: ChiCTR-TRC-14004289.

Ultrasound Features of Middle Cervical Sympathetic Ganglion

OBJECTIVES

To evaluate the feasibility of ultrasound (US) detection of the middle cervical sympathetic ganglion (CSG).

MATERIALS AND METHODS

We examined 52 consecutive patients with 104 bilateral middle CSGs. We identified middle CSG according to our sonographic assessment criteria. After finding oval-shaped hypoechoic structure on transverse scan, we verified a continuous, hypoechoic line connecting the bulbous structure at both sides. The basic US characteristics were evaluated using the size, location, relationship to the common carotid artery, and relationship to the inferior thyroidal artery.

RESULTS

The middle CSG was identified in 41% (43/104). The mean size of the middle CSG was 3.8±1.5 mm in width, 1.9±0.7 mm in height, and 8.7±3.2 mm in length. They were primarily located at the C6 level (41/43, 95%). Regarding the relationship with common carotid artery, 88% (38/43) were lateral type and 12% (5/43) were medial type. Regarding the relationship with the inferior thyroid artery, 34% (15/43) were anterior type, 26% (11/43) were posterior type, and 40% (17/43) were unable to access the relationship.

DISCUSSION

Direct visualization of middle CSG based on the understanding of both its location and US features may reduce complications and improve the accuracy of US-guided neck procedures.