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Springer S, Whitmer P, Steinlin M, Gray L, Blankfield J. Optimizing clinical outcomes with stellate ganglion block and trauma-informed care: A review article. NeuroRehabilitation 2024:NRE230236. [PMID: 38995805 DOI: 10.3233/nre-230236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
BACKGROUND For decades, thousands of active-duty service members have sought treatment for trauma exposure. Stellate ganglion block (SGB) is a fast-acting nerve block documented in medical literature for nearly a century that has shown promise as a potentially life-altering treatment for post-traumatic stress (PTS). OBJECTIVE This review aims to answer the practical questions of those who support individuals suffering from trauma: (1) SGB's safety profile (2) efficacy data (3) potential advantages and limitations, (4) a cross-cultural application example, (5) and the use of SGB in combination with talk therapy to optimize clinical outcomes. METHODS The current body of literature, to include several large case series, meta-analyses, and a sufficiently powered randomized controlled trial, were reviewed, and presented to describe the history of SGB for emotional trauma symptoms and address the objectives of this review. RESULTS Critical consideration is given to the safety and efficacy data on SGB and the evolution in safety-related technologies. Advantages such as decreased barriers to care, rapid onset, and decreased dropout and limitations such as treatment non-response, potential adverse effects, and misconceptions about the treatment are then described. Finally, the cross-cultural application of SGB is explored based on the deployment of SGB in Israel. CONCLUSION SGB is associated with level 1B evidence and a reassuring safety profile. Evolving the model of care through the combined use of effective biological treatments like SGB with trauma informed talk therapy offers a hopeful path forward for supporting those who suffer from post-traumatic stress.
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Affiliation(s)
| | - Paul Whitmer
- School of Social Work, Illinois State University, Normal, IL, USA
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Bedewi MA, Marsico S, Soliman SB, Habib YS, Kotb MA, Almalki DM, AlAseeri AA, Alhariqi BA, Alqahtani MS, Albarrak AM, Alamir AY. Sonographic imaging of the stellate ganglion in healthy adults: An observational study. Medicine (Baltimore) 2024; 103:e38646. [PMID: 38905380 PMCID: PMC11191948 DOI: 10.1097/md.0000000000038646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/30/2024] [Indexed: 06/23/2024] Open
Abstract
The aim of this study is to estimate the normal cross-sectional area and diameter of the stellate ganglion (SG) by ultrasound (US) in healthy adults. The study sample included 80 stellate ganglia in 40 participants (15 males, 25 females), mean age 38 years, mean height 162.5 cm, mean weight 67.8 kg, mean body mass index 25.4 kg/m2. Two radiologists separately obtained US images of the bilateral SG. Each participant was scanned 3 times bilaterally to assess for intra-observer reliability. The mean diameter of the SG was 1 mm (range: 0.1-2). The mean CSA of the bilateral SG was 1.3 mm2 (range: 0.6-3.9). The SG diameter positively correlated with age. Our study demonstrates the ability of US to image the SG and estimate its normal diameter and CSA. Knowledge of how to identify and measure the SG during ultrasound-guided procedures would be expected to decrease the risk of associated complications and help establish normal reference values.
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Affiliation(s)
- Mohamed A. Bedewi
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
| | | | - Steven B. Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Yomna S. Habib
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
- Department of Radiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mamdouh Ali Kotb
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
- Minia University, Faculty of Medicine, Neuropsychiatry Department, Minya, Egypt
| | - Daifallah Mohammed Almalki
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
| | - Ali Abdullah AlAseeri
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
| | - Bader A. Alhariqi
- Department of Pediatric Radiology Medical Imaging Administration, King Fahad Medical city, Kingdom of Saudi Arabia
| | - Mohammed Saad Alqahtani
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
| | - Anas Mohammad Albarrak
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
| | - Ahmed Y. Alamir
- Radiology Department Faculty of Medicine, Cairo University, Cairo, Egypt
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Ryu H, Kim H. The usefulness of stellate ganglion block with ultrasound-guided lateral paracarotid approach in ventricular arrhythmias: A case series. Saudi J Anaesth 2024; 18:276-279. [PMID: 38654862 PMCID: PMC11033875 DOI: 10.4103/sja.sja_657_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 04/26/2024] Open
Abstract
Ventricular arrhythmias are life-threatening cardiac events. Sympathetic nervous system blockade represents a crucial therapeutic method for refractory ventricular arrhythmias. Ultrasound (US) imaging for stellate ganglion block (SGB) suggests potential for its application to safer and more accurate methods. We had thirteen patients diagnosed with refractory ventricular arrhythmia and referred to the pain clinic for SGB. We visited the intensive care unit (ICU) and performed SGB with the lateral paracarotid approach technique in the ICU. Using a new approach, we easily performed SGB and felt the convenience of the procedure in the ICU. In eleven cases, we also confirmed that the effect of the block with the new technique was satisfactory. SGB, with the new technique, revealed efficiency in the recovery process of the patients. We recommended the lateral paracarotid approach technique for SGB when a patient in an ICU showed ventricular arrhythmias and should be treated with SGB.
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Affiliation(s)
- Hansung Ryu
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Hyuckgoo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Aggarwal AK, Ottestad E, Pfaff KE, Huai-Yu Li A, Xu L, Derby R, Hecht D, Hah J, Pritzlaff S, Prabhakar N, Krane E, D’Souza G, Hoydonckx Y. Review of Ultrasound-Guided Procedures in the Management of Chronic Pain. Anesthesiol Clin 2023; 41:395-470. [DOI: 10.1016/j.anclin.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Adamczyk K, Koszela K, Zaczyński A, Niedźwiecki M, Brzozowska-Mańkowska S, Gasik R. Ultrasound-Guided Blocks for Spine Surgery: Part 1-Cervix. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2098. [PMID: 36767465 PMCID: PMC9915556 DOI: 10.3390/ijerph20032098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
Postoperative pain is common following spine surgery, particularly complex procedures. The main anesthetic efforts are focused on applying multimodal analgesia beforehand, and regional anesthesia is a critical component of it. The purpose of this study is to examine the existing techniques for regional anesthesia in cervical spine surgery and to determine their effect and safety on pain reduction and postoperative patient's recovery. The electronic databases were searched for all literature pertaining to cervical nerve block procedures. The following peripheral, cervical nerve blocks were selected and described: paravertebral block, cervical plexus clock, paraspinal interfascial plane blocks such as multifidus cervicis, retrolaminar, inter-semispinal and interfacial, as well as erector spinae plane block and stellate ganglion block. Clinicians should choose more superficial techniques in the cervical region, as they have been shown to be comparably effective and less hazardous compared to paravertebral blocks.
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Affiliation(s)
- Kamil Adamczyk
- Department of Anaesthesiology and Intensive Therapy, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
- Department of Anaesthesiology, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 02-637 Warsaw, Poland
| | - Kamil Koszela
- Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Artur Zaczyński
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Marcin Niedźwiecki
- Department of Neurosurgery, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Sybilla Brzozowska-Mańkowska
- Department of Anaesthesiology, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 02-637 Warsaw, Poland
| | - Robert Gasik
- Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
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Chunyao LBS, Huiwen LMS, Yajiang ZMS, Ji LBS, Jingru YMS, Wei LMS, Jin GBS, Rong WMD. Application of Ultrasound-guided Stellate Ganglion Block in Treatment of Allergic Rhinitis. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2023. [DOI: 10.37015/audt.2023.220008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Djaali W, Mihardja H, Viventius Y, Teja Y, Bunawan HL, Setiawan M, Yunita L. The Role of Acupuncture in Interventional Pain Management. Med Acupunct 2021; 33:329-334. [PMID: 35003500 DOI: 10.1089/acu.2021.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Interventional pain management has been recognized over the last couple of decades for treating chronic-pain syndromes. Acupuncture is a nonpharmacologic therapeutic option for pain management and may be an option for different patients with contraindications for interventional pain management. This review explores this options. Method: This limited review examines the role of acupuncture for managing head-and-neck pain and lower-back pain, according to interventional pain management. Conclusions: Acupuncture at various points, corresponding to the stellate ganglion, which is ST 10 Shuitu, and corresponding to the splanchnic nerve and the facet joint of the lumbar vertebra-which are Ex-B2 paravertebra-can be applied for pain management in the head-and-neck area and in the lower-back area. According to various research findings, acupuncture is effective and safe for reducing pain in the head and neck area, as well as in the lower back.
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Affiliation(s)
- Wahyuningsih Djaali
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Universitas Negeri Jakarta, East Jakarta, DKI Jakarta, Indonesia
| | - Hasan Mihardja
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Center for the Development and Application of Traditional Medicine of DKI Jakarta, Jakarta, Indonesia
| | - Yoshua Viventius
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yolanda Teja
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hanggoro Laka Bunawan
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Marshellia Setiawan
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Lisa Yunita
- Department of Medical Acupuncture, RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia.,Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Krishna Prasad BP, Joy B, Raghavendra VA, Toms A, George D, Ray B. Ultrasound-guided peripheral nerve interventions for common pain disorders. Indian J Radiol Imaging 2021; 28:85-92. [PMID: 29692534 PMCID: PMC5894327 DOI: 10.4103/ijri.ijri_108_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There are a number of common pain disorders that can be managed effectively by injections around or ablation of peripheral nerves. Ultrasound is a universally available imaging tool, is safe, cost-effective, and is excellent in imaging many peripheral nerves and guiding needles to the site of the nerves. This article aims to present an overview of indications and techniques of such procedures that can be effectively performed by a radiologist.
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Affiliation(s)
| | - Binu Joy
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | | | - Ajith Toms
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | - Danny George
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | - Brijesh Ray
- Department of Imaging and Interventional Radiology, Aster Medcity Hospital, Cheranelloor, Ernakulam, Kerala, India
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9
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The efficacy of ultrasound-guided stellate ganglion block in alleviating postoperative pain and ventricular arrhythmias and its application prospects. Neurol Sci 2021; 42:3121-3133. [PMID: 34008041 DOI: 10.1007/s10072-021-05300-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/29/2021] [Indexed: 02/05/2023]
Abstract
Stellate ganglion block (SGB) has been applied in clinic for almost a century as a therapeutic procedure to alleviate pain-related syndromes and vascular deficits in the upper extremities. A great number of causative side effects and complications due to technological insufficiency and anatomical variations called for the popularity of ultrasound-guided SGB which has made tremendous contribution for clinical diagnosis and therapy, primarily in postoperative pain and cardiac and vascular disorders. This work was aimed at systematically summarizing the current clinical application of ultrasound-guided SGB and putting forward the potential prospective application in future. By searching ultrasound-guided SGB-related works on PubMed database, we mainly elucidated the analgesic effect of preoperative SGB in patients undergoing surgical procedures and substantial reduction in patients with ventricular arrhythmias. The volume of local anesthetics used in ultrasound-guided SGB has been diminished in the recent few years' investigations and successful operation of ultrasound-guided SGB could be achieved with minimal safe volume of local anesthetics. This invasive and safe procedure shows vast potential for future development in clinical treatment for autonomic nervous system and autoimmune disorders. We also put forward hypothesis that ultrasound-guided SGB could be applied combined with controlled hypotension to reduce the intraoperative complications in orthopedic surgery such as insufficiency of cerebral blood flow and reflexive tachycardia. Thus, it is of vital essence to improve the professional skills of physicians for the high rate of success and explore more effective measures which could enhance therapeutic effects when combined with ultrasound-guided SGB in alleviating misery of patients.
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Yu Q, Zheng E, Ding X. Evaluation of the Clinical Effect of Color Doppler Ultrasound-Guided Stellate Ganglion Block Combined with Drugs in the Treatment of Cervical Headache. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In order to evaluate the clinical effect of color Doppler ultrasound-guided stellate ganglion block combined with drugs in the treatment of cervical headache, a total of 80 patients, who were diagnosed as cervical headache at the hospital designated by this study from December 2017
to December 2018, were selected as study subjects, and were divided into 2 groups of control group and observation group according to random number table method with 40 cases in each group. The control group was treated only with drugs: 0.3 mg gabapentin orally taken 3 times a day, 0.3 mg
tizanidine hydrochloride orally taken 3 times a day, and 0.2 mg celecoxib orally taken 3 times a day for a total of 4 continuous weeks; the observation group was treated with ultrasound-guided stellate ganglion block based on the scheme of control group. The degree of patients’ pain
was evaluated by visual analogue scale (VAS), which was divided into 0–10 points; the clinical efficacy evaluation was divided into three levels: markedly effective, effective and ineffective. The results showed that the total effective rate of patients’ treatments in observation
group was 92.50%, which was significantly higher than that of 72.50% in the control group with statistically significant difference (P < 0.05); there was no statistical difference of patients’ average VAS score between the two groups before the treatment (P > 0.05),
while the average VAS score of patients in the observation group after treatment (3.58±1.46) was significantly lower than that in the control group (5.37±1.58) with statistically significant difference (P < 0.05); and there were no serious adverse reactions in both
groups. Therefore, it is believed that color Doppler ultrasound-guided stellate ganglion block combined with oral gabapentin, tizanidine hydrochloride, and celecoxib is effective in treating cervical headache. The study results of this paper provides a certain reference for further evaluations
of the clinical effect of color Doppler ultrasound-guided stellate ganglion block combined with drugs in the treatment of cervical headache.
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Affiliation(s)
- Qian Yu
- Department of Anesthesiology, Weifang People’s Hospital, Weifang, Shandong, 261000, China
| | - Enrui Zheng
- Department of Anesthesiology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, 261041, China
| | - Xiuju Ding
- Ultrasound Department of Weifang People’s Hospital, Weifang, Shandong, 261000, China
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Mohd Y, Kumar A, Sheikh I, Fatima A, Bhoi S, Jamshed N, Aggarwal P. Calming the storm - Stellate ganglion block in refractory ventricular arrhythmia in the emergency department. Am J Emerg Med 2021; 45:685.e5-685.e8. [PMID: 33436317 DOI: 10.1016/j.ajem.2020.12.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yaseen Mohd
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Irtiqa Sheikh
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Afroz Fatima
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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12
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Kaye AD, Motejunas MW, Bonneval LA, Ehrhardt KP, Latimer DR, Trescot A, Wilson KE, Ibrahim IN, Cornett EM, Urman RD, Candido KD. Ultrasound practice for chronic pain procedures: A comprehensive review. Best Pract Res Clin Anaesthesiol 2019; 33:465-486. [PMID: 31791564 DOI: 10.1016/j.bpa.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/09/2019] [Indexed: 12/11/2022]
Abstract
Chronic pain management techniques have evolved in recent years. With regard to this, ultrasound (US) technology has become a standard for most acute pain procedures and essential for postsurgical pain relief and enhanced recovery after surgery protocols. This manuscript summarizes clinical studies evaluating US use for chronic pain management and compares efficacy with standard techniques including fluoroscopy (FL). US possesses several unique benefits when compared with FL, including elimination of radiation exposure while providing similar clinical outcomes. In summary, US use for chronic pain procedures is emerging as a viable, safe, and effective modality. Additional studies are needed to best appreciate US and its role in chronic pain management.
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Affiliation(s)
- Alan David Kaye
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Mark W Motejunas
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Lauren A Bonneval
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Ken P Ehrhardt
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Dustin R Latimer
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | | | - Kyle E Wilson
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Ibraham N Ibrahim
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
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13
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Vinod K, Kurhekar P, Sharanya K, Raghuraman MS. Efficacy of the Stellate Ganglion Block Through the Lateral Approach Using Ultrasonogram and Fluoroscopy. Turk J Anaesthesiol Reanim 2018; 46:393-398. [PMID: 30263864 PMCID: PMC6157971 DOI: 10.5152/tjar.2018.45144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 04/02/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Stellate ganglion (SG) block can provide pain relief in sympathetically mediated painful conditions. SG block at the sixth cervical (C6) vertebra level through lateral approach under the ultrasonogram (USG) guidance is very safe but may spare the fibres supplying the upper limb. When the drug is given at the C6 subfascially, it spreads along the cervical sympathetic chain, blocking the head/neck and upper limb. In this study, we assessed the efficacy of the SG block given at the C6 level after confirming the subfascial needle position under USG and downward spread of dye under fluoroscopy. METHODS Ten patients with sympathetically mediated painful conditions belonging to the American Society of Anesthesiologists (ASA) Class I and II and aged between 18 and 60 years were included in the study. The SG was approached laterally under the USG guidance, and the dye was injected after confirming the subfascial needle position. A downward spread of dye was confirmed on fluoroscope, and 4 mL of 0.25% of bupivacaine with 40 mg of methylprednisolone was injected. Patients were assessed in terms of the pain relief, an increase in axillary temperature and adverse events after 30 minutes. A statistical analysis was done with Student's t-test and paired samples t-test. RESULTS There was a statistically significant reduction in the post-block pain scores with the rise in temperature in the ipsilateral arm (p=0.000). The dye spread was observed from the fourth cervical vertebra to the first thoracic vertebra in all patients. Transient hoarseness was seen in 20% of patients, and the sensation of a lump was seen in 10% of patients. CONCLUSION We conclude that SG can be blocked effectively and safely through the lateral approach at the C6 level under ultrasonogram and fluoroscopic guidance.
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Affiliation(s)
- Krishnagopal Vinod
- Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to be-University) Ammapettai, Kancheepuram, Tamilnadu, India
| | - Pranjali Kurhekar
- Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to be-University) Ammapettai, Kancheepuram, Tamilnadu, India
| | | | - M. S. Raghuraman
- Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to be-University) Ammapettai, Kancheepuram, Tamilnadu, India
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14
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Lam SKH, Reeves KD, Cheng AL. Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7920438. [PMID: 29226148 PMCID: PMC5684526 DOI: 10.1155/2017/7920438] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/19/2017] [Accepted: 07/24/2017] [Indexed: 01/29/2023]
Abstract
Deep nerve hydrodissection uses fluid injection under pressure to purposely separate nerves from areas of suspected fascial compression, which are increasingly viewed as potential perpetuating factors in recalcitrant neuropathic pain/complex regional pain. The usage of 5% dextrose water (D5W) as a primary injectate for hydrodissection, with or without low dose anesthetic, could limit anesthetic-related toxicity. An analgesic effect of 5% dextrose water (D5W) upon perineural injection in patients with chronic neuropathic pain has recently been described. Here we describe ultrasound-guided methods for hydrodissection of deep nerve structures in the upper torso, including the stellate ganglion, brachial plexus, cervical nerve roots, and paravertebral spaces. We retrospectively reviewed the outcomes of 100 hydrodissection treatments in 26 consecutive cases with a neuropathic pain duration of 16 ± 12.2 months and the mean Numeric Pain Rating Scale (NPRS) 0-10 pain level of 8.3 ± 1.3. The mean percentage of analgesia during each treatment session involving D5W injection without anesthetic was 88.1% ± 9.8%. The pretreatment Numeric Pain Rating Scale score of 8.3 ± 1.3 improved to 1.9 ± 0.9 at 2 months after the last treatment. Patients received 3.8 ± 2.6 treatments over 9.7 ± 7.8 months from the first treatment to the 2-month posttreatment follow-up. Pain improvement exceeded 50% in all cases and 75% in half. Our results confirm the analgesic effect of D5W injection and suggest that hydrodissection using D5W provides cumulative pain reduction.
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Affiliation(s)
- Stanley K. H. Lam
- Department of Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- KH Lam Musculoskeletal Pain Management and Sports Injury Centre, Kowloon, Hong Kong
- The Hong Kong Institute of Musculoskeletal Medicine, Tsuen Wan, Hong Kong
| | | | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Thapa D, Dhiman D, Ahuja V, Gombar S, Gupta RK. Tramadol sparing effect of dexmedetomidine as an adjuvant with lignocaine in preoperative stellate ganglion block for postoperative pain relief following upper limb surgeries. Br J Pain 2017; 12:26-34. [PMID: 29416862 DOI: 10.1177/2049463717720788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
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.
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Affiliation(s)
- Deepak Thapa
- Department of Anaesthesia and Intensive Care, Government Medical College & Hospital, Chandigarh, Chandigarh, India
| | - Deepanshu Dhiman
- Department of Anaesthesia and Intensive Care, Government Medical College & Hospital, Chandigarh, Chandigarh, India
| | - Vanita Ahuja
- Department of Anaesthesia and Intensive Care, Government Medical College & Hospital, Chandigarh, Chandigarh, India
| | - Satinder Gombar
- Department of Anaesthesia and Intensive Care, Government Medical College & Hospital, Chandigarh, Chandigarh, India
| | - Ravi K Gupta
- Department of Orthopaedics, Government Medical College & Hospital, Chandigarh, Chandigarh, India
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Raut MS, Maheshwari A. Stellate Ganglion Block: Important Weapon in the Anesthesiologists' Armamentarium. J Cardiothorac Vasc Anesth 2017. [PMID: 28625751 DOI: 10.1053/j.jvca.2017.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Monish S Raut
- Department of Cardiac Anesthesiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Maheshwari
- Department of Cardiac Anesthesiology, Sir Ganga Ram Hospital, New Delhi, India
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Zhao HY, Yang GT, Sun NN, Kong Y, Liu YF. Efficacy and safety of stellate ganglion block in chronic ulcerative colitis. World J Gastroenterol 2017; 23:533-539. [PMID: 28210090 PMCID: PMC5291859 DOI: 10.3748/wjg.v23.i3.533] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/18/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the efficacy and safety of stellate ganglion block for the treatment of patients with chronic ulcerative colitis.
METHODS A total of 120 randomly selected patients with chronic ulcerative colitis treated in Cangzhou Central Hospital from January 2014 to January 2016 were included in this study. These patients were divided into two groups: control group (n = 30), patients received oral sulfasalazine treatment; experimental group (n = 90), patients received stellate ganglion block treatment. Clinical symptoms and disease activity in these two groups were compared before and after treatment using endoscopy. Blood was collected from patients on day 0, 10, 20 and 30 after treatment. Enzyme-linked immunosorbent assay was performed to determine interleukin-8 (IL-8) level. The changes in IL-8 level post-treatment in the two groups were compared using repeated measures analysis of variance.
RESULTS After treatment, clinical symptoms and disease activity were shown to be alleviated by endoscopy in both the control and experimental groups. However, patients in the control group did not have obvious abdominal pain relief. In addition, the degree of pain relief in the experimental group was statistically better than that in the control group (P < 0.05). Ten days after treatment, IL-8 level was found to be significantly lower in the experimental group than in the control group, and the difference was statistically significant (P < 0.05). In addition, adverse events were significantly higher in the control group than in the experimental group, and the difference was statistically significant (χ2 = 33.215, P = 0.000).
CONCLUSION The application of stellate ganglion block effectively improves treatment efficacy in chronic ulcerative colitis, relieves clinical symptoms in patients, and reduces the level of inflammatory factors. Furthermore, this approach also had a positive impact on the disease to a certain extent.
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Abstract
OBJECTIVE The aim of this article is to provide an overview of peripheral nerve blocks, the use of peripheral nerve block within and outside interventional radiology, and the complications of peripheral nerve block. CONCLUSION Interventional radiologists are often responsible for sedation and pain management in the majority of interventional radiology procedures. Peripheral nerve block is increasingly being used in interventional radiology.
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