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Welling LC, Rabelo NN, de Sena Barbosa MG, Messias BR, Pinto CG, Figueiredo EG. Stellate ganglion block: what else is necessary to include in the treatment of subarachnoid hemorrhage patients? Chin Neurosurg J 2024; 10:21. [PMID: 39085877 PMCID: PMC11292912 DOI: 10.1186/s41016-024-00374-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/26/2024] [Indexed: 08/02/2024] Open
Abstract
Cerebral vasospasm is determined as a temporary narrowing of cerebral arteries a few days after an aneurysmal subarachnoid hemorrhage. The onset of this vascular event usually evolves with new neurological deficits or progression of ischemic areas. The success of interventions to treat or revert this condition is not satisfying. In addition to cerebral vasospasm, early brain injury plays an important role as a contributor to subarachnoid hemorrhage's mortality. In this sense, stellate ganglion block appears as an alternative to reduce sympathetic system's activation, one of the main pathophysiological mechanisms involved in brain injury. Over the past few years, there is growing evidence that stellate ganglion block can contribute to decline patient morbidity from subarachnoid hemorrhage. Is it time to include this procedure as a standard treatment after aneurysm rupture?
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Affiliation(s)
- Leonardo C Welling
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Nicollas Nunes Rabelo
- Division of Neurosurgery, School of Medicine, University of São Paulo (FMUSP)/Hospital das Clínicas, Dr. Enéas de Carvalho Aguiar Street, 255, São Paulo, SP, 05403-010, Brazil.
- Department of Neurosurgery, Atenas Medical School, Passos, MG, Brazil.
| | | | | | | | - Eberval Gadelha Figueiredo
- Division of Neurosurgery, School of Medicine, University of São Paulo (FMUSP)/Hospital das Clínicas, Dr. Enéas de Carvalho Aguiar Street, 255, São Paulo, SP, 05403-010, Brazil
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Dietz TK, Brondstater KN. Long COVID management: a mini review of current recommendations and underutilized modalities. Front Med (Lausanne) 2024; 11:1430444. [PMID: 38947233 PMCID: PMC11211541 DOI: 10.3389/fmed.2024.1430444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024] Open
Abstract
Long COVID is a condition that develops in a subset of patients after COVID-19 infection comprising of symptoms of varying severity encompassing multiple organ systems. Currently, long COVID is without consensus on a formal definition, identifiable biomarkers, and validated treatment. Long COVID is expected to be a long-term chronic condition for a subset of patients and is associated with suffering and incapacity. There is an urgent need for clear management guidelines for the primary care provider, who is essential in bridging the gap with more specialized care to improve quality of life and functionality in their patients living with long COVID. The purpose of this mini review is to provide primary care providers with the latest highlights from existing literature regarding the most common long COVID symptoms and current management recommendations. This review also highlights the underutilized interventions of stellate ganglion blocks and low-dose naltrexone, both with well-established safety profiles demonstrated to improve quality of life and functionality for patients suffering with some symptoms of long COVID, and encourages prompt referral to interventional pain management.
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Affiliation(s)
- Tiffany K. Dietz
- School of Health Professions, Shenandoah University, Winchester, VA, United States
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Fajardo Pérez M, Yamak-Altinpulluk E, Díez Tafur R, Salazar-Zamorano CH, Espinosa Morales K, Oliver-Fornies P, Rocha-Romero A, Aguilar Ureña R, Juarez-Lemus A, Galluccio F, Abd-Elsayed A. Novel ultrasound-guided supraclavicular stellate ganglion block. Pain Pract 2024; 24:808-814. [PMID: 38251786 DOI: 10.1111/papr.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Stellate ganglion block (SGB) provides diagnostic and therapeutic benefits in pain syndromes in the head, neck, and upper extremity, including complex regional pain syndrome Types I and II, Raynaud's disease, hyperhidrosis, arterial embolism in the region of the arm. METHODS We present a novel ultrasound-guided supraclavicular stellate ganglion block. Considering the existing anatomical structures of the targeted area. RESULTS AND CONCLUSIONS We hope that we can provide fewer complications and additional benefits with this new approach.
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Affiliation(s)
- Mario Fajardo Pérez
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
| | - Ece Yamak-Altinpulluk
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
- Outcomes Research Consortium, Cleveland, Ohio, USA
| | - Rodrigo Díez Tafur
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Centro MDRS - Sports, Spine & Pain Center: Lima Pain Institute, Lima, Peru
- Clínica Angloamericana British American Hospital, Lima, Peru
- Latin American Pain Society (LAPS), New York, New York, USA
| | - Carlos H Salazar-Zamorano
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Karla Espinosa Morales
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesia and Pain Medicine, Hospital de Trauma, Centro Integral de Salud de Puriscal, San José, Costa Rica
| | - Pablo Oliver-Fornies
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesiology, Critical Care and Pain Medicine, Móstoles University Hospital, Móstoles, Spain
- Aragon Institute for Health Research, Zaragoza, Spain
| | - Andrés Rocha-Romero
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesia and Pain Medicine, Hospital de Trauma, Centro Integral de Salud de Puriscal, San José, Costa Rica
- Department of Anesthesia and Pain Management, Centro Nacional de Rehabilitacion, Hospital de Trauma, San José, Costa Rica
| | - Ricardo Aguilar Ureña
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Department of Anesthesiology, Critical Care and Pain Medicine, Centro Nacional de Rehabilitacion, San José, Costa Rica
| | - Angel Juarez-Lemus
- Department of Pain Medicine, National Cancer Institute, Mexico City, Mexico
| | - Felice Galluccio
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain
- Fisiotech Lab Studio, Rheumatology and Pain Management, Firenze, Italy
- Center for Regional Anesthesia and Pain Medicine (CRAPM), Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Alaa Abd-Elsayed
- Anesthesiology Department, University of Wisconsin, Madison, Wisconsin, USA
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Shah JD, Kirkpatrick K, Shah K. Post-mastectomy Pain Syndrome: A Review Article and Emerging Treatment Modalities. Cureus 2024; 16:e56653. [PMID: 38646223 PMCID: PMC11032178 DOI: 10.7759/cureus.56653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Post-mastectomy pain syndrome (PMPS) is a syndrome broadly applied to the development of chronic pain after surgical breast intervention (i.e., lumpectomy and mastectomy). The incidence of PMPS is likely underreported, and this has contributed to a paucity of high-level evidence related to the treatment of the aforementioned condition. A drive to reduce the burden of opioid use has led to pain management physicians trialing a variety of strategies to help patients manage PMPS. This review discusses the latest evidence behind treatment options for PMPS, exploring medications as well as interventional techniques (e.g., nerve blocks, radiofrequency ablation, neuromodulation, and intrathecal drug delivery systems). Recent advances in neuromodulation technology are of particular interest here due to the well-localized nature of PMPS-related pain and the specificity with which modern neuromodulation techniques can generate an effect. Finally, the review proposes a framework with which to approach the care of patients with PMPS, with a specific emphasis on the early consideration of neuromodulation techniques along with functional and physical therapy to reduce patient medication burden and improve overall quality of life.
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Affiliation(s)
- Jay D Shah
- Anesthesiology, Baylor College of Medicine, Houston, USA
| | | | - Krishna Shah
- Anesthesiology and Interventional Pain, Baylor College of Medicine, Houston, USA
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Pearson L, Maina A, Compratt T, Harden S, Aaroe A, Copas W, Thompson L. Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study. Cureus 2023; 15:e45161. [PMID: 37711269 PMCID: PMC10498998 DOI: 10.7759/cureus.45161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/16/2023] Open
Abstract
Post-COVID-19 condition, also known as long COVID-19 syndrome and post-acute sequelae of SARS-CoV-2, encompasses an array of symptoms that persist well beyond the initial phase of the viral infection. These symptoms can range in intensity, from mild and manageable to severe and incapacitating. Due to the evolving nature of the SARS-CoV-2 pandemic, treatment protocols for the illness are in a constant state of evolution. The early stage of long COVID-19 syndrome contributes to a dearth of treatment protocols based on empirical evidence, while the absence of a conclusive pathophysiological understanding further complicates the development of such protocols. Current treatment regimens include homeopathic medicine, specialist system-focused treatments, infusion therapies, hyperbaric oxygenation, antivirals, and polypharmacy. The physiological, psychological, and societal impact of long COVID-19 cannot be approached casually and must govern the intensity with which the healthcare community approaches the treatment of long COVID-19 syndrome. In this 41-patient cohort study from a chronic pain management practice, the use of either unilateral or bilateral stellate ganglion block (SGB) was explored to manage symptoms associated with long COVID-19 syndrome. Results indicated that a substantial proportion of patients (86%) experienced a reduction of their symptoms following SGB treatment.
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Affiliation(s)
- Lisa Pearson
- Pain Management, University of South Florida, Tampa, USA
- Pain Management, Metamorphosis Ltd., Canon City, USA
- Pain Management, Texas Christian University, Fort Worth, USA
| | - Alfred Maina
- Anesthesia, Missouri State University, Springfield, USA
- Pain Management, Metamorphosis Ltd., Colorado Springs, USA
| | | | - Sherri Harden
- Pain Management, Metamorphosis Ltd., Colorado Springs, USA
| | - Abbey Aaroe
- Pain Management, Metamorphosis Ltd., Canon City, USA
| | - Whitney Copas
- Pain Management, Metamorphosis Ltd., Canon City, USA
| | - Leah Thompson
- Nursing, University of Colorado, Denver, USA
- Pain Management, Metamorphosis Ltd., Colorado Springs, USA
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Kalava A, Benyahia SA, Tico Calzada R, Staat CM. Efficacy of Stellate Ganglion Block in Treating Long-Term COVID-19-Related Olfactory and Gustatory Dysfunction: A Case Series. Cureus 2023; 15:e40929. [PMID: 37496529 PMCID: PMC10368190 DOI: 10.7759/cureus.40929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
Olfactory and gustatory dysfunction, including anosmia, parosmia, ageusia, and dysgeusia, are common long-term symptoms of coronavirus disease 2019 (COVID-19) infection. These symptoms can have a severe impact on quality of life of a patient, including psychological well-being. Stellate ganglion block (SGB) has recently been explored as a potential therapeutic intervention for these symptoms. In this case series, we present six patients with long-term COVID-19 symptoms and we detail how their symptoms evolved after an SGB. All SGB were performed under ultrasound guidance by the same physician. Patients had a right SGB during the initial visit, followed by a left SGB at a subsequent visit. All but one patient reported improvements in olfaction and gustation after the SGB. Our findings suggest that SGB may be a promising therapeutic intervention for patients with olfactory and gustatory dysfunction related to long-term COVID-19 symptoms. Further research is needed to confirm these findings and to explore the optimal treatment protocol.
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Affiliation(s)
- Arun Kalava
- Anesthesiology, University of Central Florida College of Medicine, Orlando, USA
| | - Steven A Benyahia
- Medical School, University of South Florida (USF) Health, Tampa, USA
| | - Ramon Tico Calzada
- General Medicine, Universidad de Ciencias Medicas Andrés Vesalio Guzmán (UCIMED) Escuela de Medicina, San Jose, CRI
| | - Christine M Staat
- Anesthesiology, University of South Florida (USF) Health, Tampa, USA
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