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Hu Z, Li W, Zhao G, Liang C, Li K. Postoperative stellate ganglion block to reduce myocardial injury after laparoscopic radical resection for colorectal cancer: protocol for a randomised trial. BMJ Open 2023; 13:e069183. [PMID: 37977873 PMCID: PMC10660892 DOI: 10.1136/bmjopen-2022-069183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Stellate ganglion block (SGB) is usually used in the department of algiatry. But preoperative SGB may reduce adverse cardiovascular events in high-risk patients, although evidence remains sparse. Therefore, we aim to determine whether a single-shot postoperative SGB can reduce the incidence of myocardial injury after non-cardiac surgery (MINS) and improve recovery in patients undergoing laparoscopic radical resection for colorectal cancer. METHODS AND ANALYSIS This is an investigator-initiated, single-centre, randomised, two-arm clinical trial enrolling patients aged over 45 years and scheduled for elective laparoscopic radical colorectal surgery with at least one risk factor for MINS. A total of 950 eligible patients will be randomised into a routine or block groups. The primary outcome is the incidence of MINS. The secondary outcomes include the Visual Analogue Scale of pain during rest and movement, the incidence of delirium, quality of recovery (QOR) assessed by QOR-15, and sleep quality assessed by Richards Campbell Sleep Questionnaire. Tertiary outcomes include time to first flatus, gastrointestinal complications such as anastomotic leak or ileus, length of hospital stay, collapse incidence of severe cardiovascular and cerebrovascular complications of myocardial infarction, cardiac arrest, ischaemic or haemorrhagic stroke, and all-cause mortality within 30 days after the operation. ETHICS AND DISSEMINATION The protocol was approved by Medical Ethics Committee of the China-Japan Union Hospital, Jilin University (Approval number: 2021081018) prior to recruitment. The study will be performed according to the guidelines of the Declaration of Helsinki. The findings of this study will be published and presented through various scientific forums. TRIAL REGISTRATION NUMBER ChiCTR2200055319.
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Affiliation(s)
- Zhouting Hu
- Department of Anesthesiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Wangyu Li
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | | | - Chen Liang
- New York University, New York, New York, USA
| | - Kai Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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Aleanakian R, Chung B, Feldmann RE, Benrath J. Effectiveness, Safety, and Predictive Potential in Ultrasound‐Guided Stellate Ganglion Blockades for the Treatment of Sympathetically Maintained Pain. Pain Pract 2020; 20:626-638. [DOI: 10.1111/papr.12892] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Ruben Aleanakian
- Clinic of Anesthesiology and Intensive Care Medicine Pain Center Medical Faculty Mannheim University Medical Center Mannheim Heidelberg University Mannheim Germany
| | - Boo‐Young Chung
- Clinic of Anesthesiology and Intensive Care Medicine Pain Center Medical Faculty Mannheim University Medical Center Mannheim Heidelberg University Mannheim Germany
| | - Robert E. Feldmann
- Clinic of Anesthesiology and Intensive Care Medicine Pain Center Medical Faculty Mannheim University Medical Center Mannheim Heidelberg University Mannheim Germany
| | - Justus Benrath
- Clinic of Anesthesiology and Intensive Care Medicine Pain Center Medical Faculty Mannheim University Medical Center Mannheim Heidelberg University Mannheim Germany
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Liao CD, Rau CL, Liou TH, Tsauo JY, Lin LF. Effects of Linearly Polarized Near-Infrared Irradiation Near the Stellate Ganglion Region on Pain and Heart Rate Variability in Patients with Neuropathic Pain. PAIN MEDICINE 2017; 18:488-503. [PMID: 27452896 DOI: 10.1093/pm/pnw145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Neuropathic pain associated with sympathetic overactivity can be effectively relieved by light irradiating the region near stellate ganglion (SGI), applied as an alternative to a conventional sympathetic blockade. The clinical effect of SGI on heart rate variability (HRV) and its association with pain outcomes require investigation. Objective This study attempted to identify the effects of SGI on pain outcomes and HRV indices and to determine the association between pain and HRV outcomes. Design A prospective double-blind, randomized study. Setting An outpatient pain medicine clinic. Subjects and Methods A total of 44 patients were enrolled and randomized into the experimental group ( n = 22) and control group ( n = 22). The experimental group received 12 sessions (twice weekly) of standard SGI, whereas the control group received the same protocol with sham irradiation. Pain and HRV were measured before and after each irradiation session. All outcome measures used in the first- and second-half treatment courses were analyzed. Results Pain and HRV outcome measures of the experimental group significantly improved after SGI when compared with the control group in both courses. Considering time and frequency domains, the changes in HRV in the second-half treatment course exceeded those in the first-half treatment course. Pain was significantly associated with postirradiated HRV indices ( P < 0.001). Conclusions Twelve sessions of SGI exerted time-dependent positive effects on pain and sympathovagal imbalance. HRV outcomes, including time and frequency domains, were an independent indicator of the clinical efficiency of SGI for treating pain in patients with neuropathic pain.
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Affiliation(s)
- Chun-De Liao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Lun Rau
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.,School of Gerontology and Health Management, Taipei Medical University, Taipei, Taiwan
| | - Jau-Yih Tsauo
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Chen YQ, Xie YY, Wang B, Jin XJ. Effect of stellate ganglion block on hemodynamics and stress responses during CO2-pneumoperitoneum in elderly patients. J Clin Anesth 2017; 37:149-153. [DOI: 10.1016/j.jclinane.2016.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 11/02/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
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Antioxidation Role of Different Lateral Stellate Ganglion Block in Isoproterenol-Induced Acute Myocardial Ischemia in Rats. Reg Anesth Pain Med 2017; 42:588-599. [DOI: 10.1097/aap.0000000000000647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Effects of ultrasound-guided stellate ganglion block on autonomic nervous function during CO2-pneumoperitoneum: A randomized double-blind control trial. J Clin Anesth 2016; 32:255-61. [PMID: 27290985 DOI: 10.1016/j.jclinane.2016.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/18/2016] [Accepted: 03/01/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND CO2-pneumoperitoneum can cause sympathetic nerve activity increased and is likely to causes severe stress-related homeostatic disorders. OBJECTIVE Patients undergoing elective laparoscopic cholecystectomy were administered type-B ultrasound-guided stellate ganglion block (SGB) to observe the effects on autonomic nervous system during CO2- pneumoperitoneum. DESIGN A randomized, double-blinded, and placebo-controlled study. SETTING University-affiliated teaching hospital. PATIENTS Eighty patients (aged 32-75 years; weight, 45-80 kg; American Society of Anesthesiologists (ASA) physical status classification, class I or II) undergoing elective laparoscopic cholecystectomy. INTERVENTIONS The RSGB group was administered lidocaine 1% 7 ml under ultrasound guidance. MAIN OUTCOME MEASURES The low frequency (LF), high frequency (HF), total power (TP) and LF/HF ratio were recorded before the block (T0), 5 min (T1) and 30 min (T2) following pneumoperitoneum, 5 min after deflation of pneumoperitoneum (T3) and after surgery (T4). The low-frequency normalized unit (LFnu) and high-frequency normalized units (HFnu) were calculated. RESULTS Compared with T0, LF, LFnu and LF/HF ratio were significantly elevated at T1-4 (all P< .05 or .01). HFnu was significantly decreased at T2-4 in control group (P< .05) while HF was significantly elevated (P< .01). The LF/HF ratio was significantly decreased (P< .05) at T1-4 in RSGB group. Compared with control group, the LF, LFnu and LF/HF ratio were significantly decreased (P< .05) and HF and HFnu was significantly elevated (P< .05 or .01) at T1-4 in RSGB group. CONCLUSION Ultrasound-guided RSGB inhibited CO2-pneumoperitoneum-induced sympathetic neural excitation, upregulated vagal nerve stimulation and maintained stable autonomic nervous function.
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Effects of stellate ganglion block on cardiovascular reaction and heart rate variability in elderly patients during anesthesia induction and endotracheal intubation. J Clin Anesth 2015; 27:140-5. [PMID: 25559299 DOI: 10.1016/j.jclinane.2014.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 05/19/2014] [Accepted: 06/09/2014] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVE To investigate the effects of stellate ganglion block (SGB) on cardiovascular response and heart rate (HR) variability in elderly patients during anesthesia induction and endotracheal intubation. DESIGN A randomized, double-blinded, and placebo-controlled study. SETTING University-affiliated teaching hospital. PARTICIPANTS Eighty elderly patients (American Society of Anesthesiologists grades I and II) receiving elective surgery during general anesthesia. INTERVENTIONS Right stellate ganglion injection (SGB) was performed in all patients using 10 mL of 1% lidocaine or normal saline. MEASUREMENTS Systolic blood pressure (BP), diastolic BP, HR, and calculated rate pressure product. HR variability at the following time points: conscious status before induction (T0); immediately before intubation (T1); immediately after intubation (T2); and 1, 3, and 5 minutes postintubation (T3, T4, and T5). MAIN RESULTS No significant differences in BP and HR were observed between the 2 groups. Rate pressure product values significantly increased in the control group compared with baseline and SGB group values. Low-frequency power (LF) and LF/high-frequency power (HF) significantly increased, and HF and normalized units of HF significantly decreased in the control group compared with baseline values. LF, normalized units of LF, and LF/HF in the SGB group significantly decreased compared with those of the control group. CONCLUSION SGB protects the myocardium and effectively suppresses stress responses during anesthesia induction and tracheal intubation in elderly patients.
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Larsen SL, Lyngeraa TS, Maschmann CP, Van Lieshout JJ, Pott FC. Cardiovascular consequence of reclining vs. sitting beach-chair body position for induction of anesthesia. Front Physiol 2014; 5:187. [PMID: 24904427 PMCID: PMC4032912 DOI: 10.3389/fphys.2014.00187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/26/2014] [Indexed: 11/13/2022] Open
Abstract
The sitting beach-chair position is regularly used for shoulder surgery and anesthesia may be induced in that position. We tested the hypothesis that the cardiovascular challenge induced by induction of anesthesia is attenuated if the patient is placed in a reclining beach-chair position. Anesthesia was induced with propofol in the sitting beach-chair (n = 15) or with the beach-chair tilted backwards to a reclining beach-chair position (n = 15). The last group was stepwise tilted to the sitting beach-chair position prior to surgery. Hypotension was treated with ephedrine. Continuous hemodynamic variables were recorded by photoplethysmography and frontal cerebral oxygenation (ScO2) by near infrared spectroscopy. Significant differences were only observed immediately after the induction when patients induced in a reclining beach-chair position had higher mean arterial pressure (MAP) (35 ± 12 vs. 45 ± 15 % reduction from baseline, p = 0.04) and ScO2 (7 ± 6 vs. 1 ± 8% increase from baseline, p = 0.02) and received less ephedrine (mean: 4 vs. 13 mg, p = 0.048). The higher blood pressure and lower need of vasopressor following induction of anesthesia in the reclining compared to the sitting beach-chair position indicate more stable hemodynamics with the clinical implication that anesthesia should not be induced with the patient in the sitting position.
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Affiliation(s)
- Søren L Larsen
- Department of Anesthesiology, Bispebjerg Hospital, University of Copenhagen Denmark
| | - Tobias S Lyngeraa
- Department of Anesthesiology, Bispebjerg Hospital, University of Copenhagen Denmark
| | | | - Johannes J Van Lieshout
- Acute Admissions Unit, Laboratory for Clinical Cardiovascular Physiology, Department of Internal Medicine, AMC Center for Heart Failure University of Amsterdam, Netherlands ; Queen's Medical Centre, School of Life Sciences, University of Nottingham Medical School Nottingham, UK
| | - Frank C Pott
- Department of Anesthesiology, Bispebjerg Hospital, University of Copenhagen Denmark
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Simeoforidou M, Vretzakis G, Chantzi E, Bareka M, Tsiaka K, Iatrou C, Karachalios T. Effect of interscalene brachial plexus block on heart rate variability. Korean J Anesthesiol 2013; 64:432-8. [PMID: 23741566 PMCID: PMC3668105 DOI: 10.4097/kjae.2013.64.5.432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 10/24/2012] [Accepted: 10/29/2012] [Indexed: 11/18/2022] Open
Abstract
Background Interscalene brachial plexus block (ISB) may be followed by cardiovascular instability. Until date, there is no clear picture available about the underlying mechanisms of ISB. In this study, we aimed to determine the changes in heart rate variability (HRV) parameters after ISB and the differences between right- and left-sided ISBs. Methods We prospectively studied 24 patients operated for shoulder surgery in sitting position and divided them into two respective groups: R (right-sided block = 14 pts) and L (left-sided block = 10 pts). HRV data were taken before and 30 min after the block. Ropivacaine without ephedrine was used for the ISB through an insulated block needle connected to a nerve stimulator. Statistical analysis implemented chi-square, Student's and t-paired tests. Skewed distributions were analyzed after logarithmic transformation. Results All the studied patients had successful blocks. Horner's syndrome signs were observed in 33.3% of the patients (R = 5/14, L = 3/10; [P = 0.769]). There were no significant differences in pre-block HRV between the groups. The application of ISB had differential effect on HRV variables: R-blocks increased QRS and QTc durations and InPNN50, while a statistical decrease was seen in InLF. L-blocks did not show any significant changes. These changes indicate a reduced sympathetic and an increased parasympathetic influence on the heart's autonomic flow after R-block. Conclusions Based on the obtained results we conclude that ISB, possibly through extension of block to the ipsilateral stellate ganglion, alters the autonomic outflow to the central circulatory system in a way depending on the block's side.
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Song SY, Roh WS. Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks. Korean J Anesthesiol 2012; 62:209-19. [PMID: 22474545 PMCID: PMC3315648 DOI: 10.4097/kjae.2012.62.3.209] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 02/29/2012] [Accepted: 03/01/2012] [Indexed: 11/10/2022] Open
Abstract
Sudden, profound hypotensive and bradycardic events (HBEs) have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. Although HBEs may be associated with the adverse effects of interscalene brachial plexus block (ISBPB) in the sitting position, the underlying mechanisms responsible for HBEs during the course of shoulder surgery are not well understood. The basic mechanisms of HBEs may be associated with the underlying mechanisms responsible for vasovagal syncope, carotid sinus hypersensitivity or orthostatic syncope. In this review, we discussed the possible mechanisms of HBEs during shoulder arthroscopic surgery, in the sitting position, under ISBPB. In particular, we focused on the relationship between HBEs and various types of syncopal reactions, the relationship between HBEs and the Bezold-Jarisch reflex, and the new contributing factors for the occurrence of HBEs, such as stellate ganglion block or the intraoperative administration of intravenous fentanyl.
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Affiliation(s)
- Seok Young Song
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea
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Song JG, Hwang GS, Lee EH, Leem JG, Lee C, Park PH, Shin JW. Effects of bilateral stellate ganglion block on autonomic cardiovascular regulation. Circ J 2009; 73:1909-13. [PMID: 19713654 DOI: 10.1253/circj.cj-09-0244] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Stellate ganglion block (SGB) is performed for the diagnosis and treatment of sympathetic dependent pain in the head, neck and upper limbs. However, the effects of bilateral SGB on cardiovascular and autonomic regulation remain unknown. The aim of this study was to assess the effects of bilateral SGB on cardiovascular and autonomic function by measuring heart rate variability (HRV), systolic blood pressure variability (SBPV) and spontaneous baroreflex sensitivity (SBRS). METHODS AND RESULTS Twenty healthy volunteers were randomly allocated to receive right or left SGB with 8 ml 1% lidocaine solution; after 20 min, the contralateral side SGB was performed. Changes in the RR interval (RRI), systolic blood pressure (SBP), HRV, SBPV and SBRS were assessed before and after bilateral SGB. The low-frequency (LF, 0.04-0.15 Hz) and high-frequency (HF, 0.15-0.4 Hz) components of HRV and SBRS decreased significantly; however, no significant changes were found in RRI, SBP and the LF and HF components of SBPV after bilateral SGB. In subjects with symptoms of vagal blockade, HRV, SBP and SBRS were significantly affected by bilateral SGB. CONCLUSIONS Bilateral SGB should be performed cautiously because it can reduce cardiac vagal modulation and BRS, especially for those with symptoms of vagal blockade after bilateral SGB.
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Affiliation(s)
- Jun-Gol Song
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yildirim V, Akay HT, Bingol H, Bolcal C, Iyem H, Doğanci S, Demirkilic U, Tatar H. Pre-emptive stellate ganglion block increases the patency of radial artery grafts in coronary artery bypass surgery. Acta Anaesthesiol Scand 2007; 51:434-40. [PMID: 17378781 DOI: 10.1111/j.1399-6576.2006.01260.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We evaluated the role of pre-emptive stellate ganglion block (SGB) in preventing radial artery spasm and increasing radial artery graft patency in patients undergoing off-pump coronary artery bypass surgery. METHODS In this prospective randomized study, 100 patients were divided into two equal groups (n= 50). In group A, SGB was achieved using 10 ml of ropivacaine and, in group B, SGB was not performed. Radial artery blood flow was measured pre- and intra-operatively. Post-operative clinical determinants (S-T segment elevation, use of inotropic agents, incidence of atrial fibrillation) were recorded. Early coronary angiography was performed. RESULTS According to blood flowmeter measurements, the radial artery blood flow was significantly increased in patients with SGB. The incidence of atrial fibrillation, the need for inotropic agents and S-T segment elevation were all decreased in the SGB group. Angiographic intervention revealed that the incidence of graft spasm was also lower in the SGB group. CONCLUSION Pre-emptive SGB is an effective method for increasing radial artery blood flow and preventing radial artery spasm. Complications related to radial artery spasm may be decreased and patients may have a more comfortable post-operative period with this method.
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Affiliation(s)
- V Yildirim
- Department of Anesthesiology and Reanimation, Gulhane Military Medical Academy, Ankara, Turkey
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Wang QX, Wang XY, Fu NA, Liu JY, Yao SL. Stellate ganglion block inhibits formalin-induced nociceptive responses: mechanism of action. Eur J Anaesthesiol 2006; 22:913-8. [PMID: 16318661 DOI: 10.1017/s0265021505001559] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2005] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Stellate ganglion block has been extensively used in clinical practice for the management of painful conditions such as cephalic, facial and upper limb pains yet its mechanism of action and its analgesic efficacy are poorly understood. METHOD Formalin (3% 0.2 mL) was injected into the plantar region of the right upper limb paw in rabbits and 50 min after this injection, saline or bupivacaine 2.5% 0.5 mL was administered via a chronic implantation catheter near the right stellate ganglion. Behavioural modification, changes in heart rate and plasma norepinephrine release at different time points after formalin and bupivacaine or saline injection were observed. Finally, the cervical spinal cord was harvested and immunostaining for substance P and c-Fos was performed. RESULTS Formalin caused stress noxious behavioural changes and a significant increase in heart rate and norepinephrine release. These changes were inhibited by bupivacaine stellate ganglion block but not by saline injection. Immunoreactants of substance P were significantly decreased by formalin injection compared with that in controls. However, with bupivacaine injection, substance P levels were restored though not reaching the levels seen in the controls. Formalin injection also caused a significant increase of c-Fos expression in cervical spinal cord. This increase was not affected by stellate ganglion block. CONCLUSION Stellate ganglion block can effectively alleviate nociceptive responses induced by formalin injection. The mechanism of its action may involve reduction of substance P in the spinal cord and plasma catecholamine release caused by noxious stimuli.
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Affiliation(s)
- Q X Wang
- People's Hospital, Yunyang Medical College, Department of Anesthesiology, Shiyan, Hubei Province, PR China.
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Nacitarhan V, Elden H, Kisa M, Kaptanoğglu E, Nacitarhan S. The effects of therapeutic ultrasound on heart rate variability: a placebo controlled trial. ULTRASOUND IN MEDICINE & BIOLOGY 2005; 31:643-8. [PMID: 15866414 DOI: 10.1016/j.ultrasmedbio.2005.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Revised: 01/24/2005] [Accepted: 01/27/2005] [Indexed: 05/02/2023]
Abstract
The effect of therapeutic ultrasound (US) on nervous system is controversial and the effect on autonomic nervous system is not clear. Therefore, the present placebo-controlled trial was planned to investigate the effects of therapeutic US application on right-side stellate ganglion, by using analysis of heart rate variability (HRV). A total 12 healthy volunteers were included in the study. RR intervals were recorded for 5 min before and after the US application, in supine and sitting positions. All procedures were repeated in all participants with sham US one week later. The heart rate (HR) was obtained by time-domain analysis and low frequency (LF) power (%), high frequency (HF) power (%) and LF/HF ratio values were obtained by frequency-domain (power spectral density) analysis. After the US application, there was a decrease in the HR (p = 0.002) and the HF power (%) component (p = 0.015) in supine position and a decrease in HR (p = 0.002) and LF/HF ratio (p = 0.028) in sitting position. There was no significant difference after the sham US application. In conclusion, we observed that therapeutic US application on stellate ganglion causes alterations on HRV parameters.
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Affiliation(s)
- Vedat Nacitarhan
- Cumhuriyet University, Medicine Faculty, Department of Physical Medicine and Rehabilitation, Sivas, Turkey.
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Abdi S, Zhou Y, Doshi R, Patel N. Stellate ganglion block: Emphasis on the new oblique fluoroscopic approach. ACTA ACUST UNITED AC 2005. [DOI: 10.1053/j.trap.2005.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Saxena AK, Saxena N, Aggarwal B, Sethi AK. An Unusual Complication of Sinus Arrest Following Right-Sided Stellate Ganglion Block: A Case Report. Pain Pract 2004; 4:245-8. [PMID: 17173606 DOI: 10.1111/j.1533-2500.2004.04309.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We present a case of a 29-year-old female patient who had presented to us for the management of her chronic right shoulder-hand pain and developed a sinus arrest following a right-sided stellate ganglion block (RSGB). This patient on receiving a diagnostic RSGB via the anterior paratracheal (C6) approach developed sinus arrest followed by apnea and unconsciousness. On institution of resuscitative measures involving tracheal intubation, positive pressure ventilation, cardiac massage, and intravenous atropine, spontaneous cardiac activity recovered in about 3 minutes. Other signs and symptoms resolved fully in a total of 10 minutes. She had persistent postural hypotension lasting for about 24 hours requiring bed rest and was discharged about 36 hours after the procedure, without any adverse sequelae. As the sinus node is supplied by the right-sided sympathetic chain, its blockade probably resulted in unopposed parasympathetic activity leading to asystole. Available evidence of the role of right stellate ganglion in regulation of cardiac electrophysiology and functioning is also discussed.
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Affiliation(s)
- Ashok K Saxena
- Pain Clinic, Department of Anesthesiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Shahdara, India.
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Arai YCP, Ogata J, Matsumoto Y, Yonemura H, Kido K, Uchida T, Ueda W. Preoperative stellate ganglion blockade prevents tourniquet-induced hypertension during general anesthesia. Acta Anaesthesiol Scand 2004; 48:613-8. [PMID: 15101858 DOI: 10.1111/j.0001-5172.2004.00389.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prolonged and excessive inflation of pneumatic tourniquets leads to a hyperdynamic circulatory response. Sympathomimetic activity is an important factor in tourniquet-induced hypertension. Stellate ganglion block specifically blunts sympathetic efferent nerves and prevents hypertension induced by sympathomimetic stimulation. The present study was performed to investigate the effects of stellate ganglion block (SGB) on arterial pressure and heart rate during prolonged tourniquet use under general anesthesia. METHODS Twenty patients scheduled for knee arthroscopy were either treated with 10 ml of 1% lidocaine for SGB (SGB group; n = 10), or intramuscular injection (IM group; n = 10) before tourniquet inflation. Comparisons of systolic and diastolic arterial pressure and heart rate were made before and after the induction of anesthesia, 10 min after the lidocaine treatment, every 5 min during the first 60 min after tourniquet inflation, and immediately before and 5 min following deflation. The maximum values of the circulatory variables were compared. RESULTS Tourniquet inflation caused increases in the circulatory variables in both groups. Systolic arterial pressure in the SGB group was significantly lower than that in the IM group after 55 min of tourniquet inflation. Diastolic arterial pressure also was significantly lower in the SGB group immediately before the deflation. The maximum values of the three hemodynamic variables were significantly lower in the SGB group. Arterial pressure significantly decreased after tourniquet deflation in the IM group. CONCLUSION Ipsilateral SGB attenuated the hyperdynamic response mediated by prolonged tourniquet inflation during knee arthroscopy.
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Affiliation(s)
- Y-C P Arai
- Department of Anesthesiology, Ehime Rosai Hospital, Ehime, Japan.
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