Ultrasound guided injections of botulinum toxin type A into stellate ganglion to treat insomnia

Visualizing stellate ganglion with US imaging for guided SGB treatment: A feasibility study with healthy adults

Objective

As for ultrasound (US) guided stellate ganglion (SG) block, unsatisfactory curative outcomes and complications still remain. This problem could be greatly improved by identifying and monitoring SG. To the best of our knowledge, there are few reports to directly visualize SG in literature. This study explored the feasibility of detection of SG and summarized the findings of SG through US.

Methods

Fifty healthy adults with 100 SGs were enrolled. The size, shape, echogenicity, margin, the inferior pole of SG, the relationship between the superior pole of SG and the transverse process, the relationship between the superior pole of SG and the inferior thyroid artery, and the relationships between SG and other surrounding tissues were evaluated by US.

Results

The SG was identified in 79% of the participants. No significant differences were found between the right and left sides regarding thickness, cross-sectional area (CSA), and position (all p > 0.05); however, there was a significant difference in the width of the right and left sides (p < 0.05). Side was associated with SG visibility (p < 0.05), however, the gender was not (p > 0.05). A total of 42% of SGs were oval-shaped. All SGs were hyperechogenic and had an ill-defined margin. In fact, 63% of SGs were located in the C7 transverse process level, 77% of SGs were located under the inferior thyroid artery, and all of these SGs were located lateral to the thyroid and medial to the anterior scalene muscle and the vagus nerve.

Conclusion

Our preliminary study demonstrates that US imaging provides the capability of detecting SG. This may be helpful in minimizing complications and improving the accuracy of US-guided SG 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 &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.