The prolongation of pulse transit time after a stellate ganglion block: An objective indicator of successful block

Objective Evaluation of Stellate Ganglion Block Effects Using Ultrasound Wave Intensity Technology: A Study on Hemodynamics

Purpose

Emerging evidence suggests that although Horner's syndrome manifests observable facial changes, it may not comprehensively evaluate the hemodynamic alterations associated with stellate ganglion block (SGB). This study endeavors to systematically evaluate the influence of SGB on the elasticity and flow velocity of the common carotid artery (CCA) and brachial artery utilizing ultrasound wave intensity analysis (usWIA). Particularly, it focuses on patients necessitating monitoring for its effects on specific organs or regions.

Methods

Totally, we selected 33 patients, where only 31 patients (comprising 15 males and 16 females) were included between September 2020 to January 2022 after screening patients who require SGB treatment for painful disorders. The side on which the SGB was administered depended on the patient's painful side, 13 cases underwent left stellate ganglion block (LSGB), and 18 cases underwent right stellate ganglion block (RSGB). Wave intensity (WI) data were collected by usWIA on the CCA and brachial artery before the administration of SGB and after the manifestation of Horner's syndrome. We then compared the changes in these data pre- and post-SGB using SPSS 26.0.

Results

The results showed an increase in arterial compliance (AC) of the CCA and brachial artery on the blocked side after SGB (P < 0.05). In contrast, pressure-strain elastic modulus (EP) and arterial stiffness pulse wave velocity (PWVβ) decreased (for all P < 0.05). Furthermore, the minimum velocity (Vmin) of the CCA exhibited a significant increase (P < 0.01), while wave intensity pulse wave velocity (PWVwi) was significantly reduced (P < 0.01). In contrast, on the contralateral side of the CCA, EP and PWVβ increased after SGB (for all P < 0.05), while AC decreased (P < 0.05).

Conclusion

SGB has been observed to enhance the elasticity and blood flow velocity of arteries within its innervated areas. In clinical practice, usWIA can serve as an objective measurement tool for assessing the impact of SGB on arterial elasticity and flow velocity in specific organs or regions. Furthermore, unilateral SGB has been noted to diminish the arterial elasticity of the CCA on the contralateral side.

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 &lt; 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 &gt; 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.

Effect of Stellate Ganglion Block on the Regional Hemodynamics of the Upper Extremity: A Randomized Controlled Trial

BACKGROUND

The success of stellate ganglion block (SGB) is traditionally determined on the basis of findings such as Horner's syndrome, temperature rise in the face, hyperemia of the tympanic membrane, and nasal congestion. However, decreases in vascular resistance and increases in blood flow in the arm may be more meaningful findings. To date, the effect of SGB on the regional hemodynamics of the arm has not been evaluated using pulsed-wave Doppler ultrasound.

METHODS

A total of 52 patients who were to undergo orthopedic surgery of the forearm were randomly assigned to either the mepivacaine group (SGB with 5 mL of 0.5% mepivacaine) or the saline group (SGB with 5 mL of normal saline). Before surgery, a single anesthesiologist performed a SGB under ultrasound guidance. The temperature of the upper extremity and the resistance index and blood flow in the brachial artery were measured before SGB, 15 and 30 minutes after SGB, and 1 hour after surgery. The severity of pain, requirement for rescue analgesics, and side effects of the local anesthetic agent were all documented.

RESULTS

After SGB, the resistance index decreased significantly and the blood flow increased significantly in the brachial artery of members of the mepivacaine group (15 minutes: P = .004 and P < .001, respectively; 30 minutes: P < .001 and P < .001, respectively). However, these values normalized after surgery. The severity of pain, need for rescue analgesics, and incidence of adverse effects were not significantly different between the 2 groups.

CONCLUSIONS

Although SGB did not decrease the pain associated with forearm surgery, ultrasound-guided SGB did increase blood flow and decrease vascular resistance in the arm. Therefore, pulsed-wave Doppler may be used to monitor the success of SGB.

Detection of the Stellate and Thoracic Sympathetic Chain Ganglia with High-Resolution 3D-CISS MR Imaging

BACKGROUND AND PURPOSE

Despite the importance of the sympathetic nervous system in homeostasis and its putative role in various disease states, little is known regarding our ability to image the sympathetic chain and sympathetic chain ganglia, perhaps owing to their small size. In this retrospective study, we sought to evaluate the normal anatomy of the sympathetic chain ganglia and assess the detectability of the sympathetic chain and sympathetic chain ganglia on high-resolution 3D-CISS images.

MATERIALS AND METHODS

This study included 29 patients who underwent 3D-CISS MR imaging of the thoracic spine for reasons unrelated to abnormalities of the sympathetic nervous system. Patients with a prior spinal operation or visible spinal pathology were excluded. The sympathetic chain ganglia were evaluated using noncontrast 3D-CISS MR imaging. Statistical analyses included t tests and measures of central tendency. The Cohen κ statistic was calculated to evaluate interrater reliability.

RESULTS

The stellate ganglion and thoracic chain ganglia were identified in all subjects except at the T10-T11 and T11-T12 levels. The stellate ganglion was found inferomedial to the subclavian artery and anterior and inferior to the transverse process of C7 in all subjects. Thoracic sympathetic chain ganglia were identified ventral to the costovertebral junction in all subjects from T2 to T10. There was strong interobserver agreement for the detection of the sympathetic chain ganglia with κ > 0.80. The size, shape, and location of these structures corresponded with gross anatomic and surgical observations.

CONCLUSIONS

The thoracic sympathetic chain ganglia can be identified on precontrast 3D-CISS MR imaging. This technique may aid in the initial evaluation of stellate ganglion and/or sympathetic chain ganglia size and signal change for comparison in future studies.

Tramadol sparing effect of dexmedetomidine as an adjuvant with lignocaine in preoperative stellate ganglion block for postoperative pain relief following upper limb surgeries

Background

Recent literature has established the role of stellate ganglion block (SGB) for management of acute postoperative pain. The effects of dexmedetomidine as an adjuvant to lignocaine in a preoperative SGB for postoperative pain relief have not been evaluated so far.

Methods

The following randomised, double-blinded, control trail included 54 patients scheduled for upper limb orthopaedic surgery under general anaesthesia. Preoperative ultrasound-guided (USG) SGB was performed in all patients. Group I (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 μg/kg dexmedetomidine for SGB) and 15 mL of intravenous (IV) normal saline (NS). Group II (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL NS for SGB) and 15 mL of IV NS. Group III (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL of NS for SGB) and 0.5 μg/kg dexmedetomidine in 15 mL of IV NS. Postoperatively tramadol consumption and Visual Analogue Scale (VAS) score were recorded up to 48 hours.

Results

The cumulative tramadol consumption at the end of 48 hours (p = 0.01) was significantly reduced in the group I as compared to group II. In group I, postoperative VAS at rest was significantly reduced up to 12 hours postoperatively as compared to group II (p = 0.05). The cumulative tramadol consumption was not reduced significantly in group III compared to group II (p = 0.51).

Conclusion

Dexmedetomidine as an adjuvant to SGB along with lignocaine produced a significant tramadol sparing effect and superior analgesia as compared to IV dexmedetomidine and control group.¹.