Possible inadvertent subdural block following attempted stellate ganglion blockade

A case is reported of suspected inadvertent subdural block following attempted stellate ganglion blockade for relief of cervicobrachial pain in a patient suffering from reflex sympathetic dystrophy. Possible complications due to neuraxial spread of local anaesthetics while performing a cervicothoracic ganglion blockade are considered.     

Severe hypertension after stellate ganglion block

Haemodynamic effects may occur after stellate ganglion block(SGB) arising from autonomic imbalance and local anaestheticinfiltration to barosensitive areas. We report seven patientswho developed severe hypertension (systolic arterial pressure>200 mm Hg) after SGB in our pain clinic service. We postulatethat diffusion of the local anaesthetic along the carotid sheathmay produce vagal blockade causing unopposed sympathetic activityas a result of attenuation of the baroreceptor reflex. We recommendclose monitoring of arterial pressure measurement in patientswho received SGB.     

Intercostal neuralgia following stellate ganglion block

The case is described of a 78-year-old female patient who experienced temporary but severe chest wall pain following stellate ganglion block. The possible mechanisms and treatment of this complication are discussed.     

Assessment of diaphragm function after stellate ganglion block using magnetic stimulation

Stellate ganglion block is a procedure frequently used for the management of patients with chronic sympathetically mediated pain affecting the arm, neck or head. We studied the effect of stellate ganglion block on ipsilateral phrenic nerve function, and hence diaphragmatic strength, in 11 adult patients with chronic sympathetically mediated pain. Pre- and post-block forced vital capacity (FVC) measurements were recorded using a pneumotachograph and a Magstim nerve stimulator was used to generate pre- and post-block twitch mouth pressures (P(TWM)). This device can be used to stimulate the phrenic nerves and hence the diaphragm. The resulting change in airway pressure was measured at the mouth and has previously been shown to reflect diaphragm strength. There was no statistically significant difference in FVC or P(TWM) pre- or post stellate ganglion block. In conclusion, a stellate ganglion block has no adverse effect on ipsilateral phrenic nerve function or diaphragm strength in healthy adult patients.     

Dural puncture during attempted stellate ganglion block

Dural puncture is rarely reported as a complication of stellate ganglion blockade. Breach of the dura occurred in the case described because of the anatomy of the cervical spine.     

Differences of regional blood flow after stellate ganglion block with local anesthetic and that after stellate ganglion resection using ultrasonic Doppler flowmeter]

Ten mongrel dogs were divided into two groups; stellate ganglion block (SGB, n = 5) group and stellate ganglion resection (SGR, n = 5) group. Anesthesia was induced with pentobarbital 25 mg.kg-1. The animals were mechanically ventilated to maintain a constant PaCO2 (35-40 mmHg). Left common carotid arterial flow (CCAF), left external carotid arterial flow (ECAF), left vertebral arterial flow (VAF) and left brachial arterial flow (BAF) were measured using an ultrasonic transit time flowmeter. Internal carotid arterial flow (ICAF) was calculated by subtracting ECAF from CCAF. After thoracotomy, the first SGB with 0.5% mepivacaine 1.5 ml or SGR was performed. Ninety minutes after the first SGB, the second SGB was performed. The data were taken for 180 minutes after the first SGB or SGR. In SGB, CCAF and BAF increased significantly for the duration of action of local anesthetic. But VAF and ICAF increased significantly for a short time after the block. In SGR, CCAF, BAF and ICAF increased significantly during the experiment. But VAF showed a transitory increase immediately after the resection. The authors conclude that sympathetic ganglion block with local anesthetic should be performed repeatedly when increase of blood flow in blood vessels with strong autoregulation from the brain is anticipated.     

右侧星状神经节阻滞对腹腔镜胆囊切除术后肩痛的影响

目的 探讨右侧星状神经节阻滞(SGB)对腹腔镜胆囊切除术(LC)患者术后肩痛的影响。方法 选择2022年4—8月行LC患者104例,男32例,女72例,年龄18～64岁,ASAⅠ或Ⅱ级。将患者随机分为两组：SGB组(S组,n=51)和对照组(C组,n=53)。气管插管后即刻,S组使用0.2%罗哌卡因4 ml进行超声引导下的右侧SGB;C组在相同部位注射生理盐水4 ml。记录术后48 h内腹腔镜术后肩痛(PLSP)例数和PLSP持续时间;记录术毕即刻(T₁)、术后2 h(T₂)、6 h(T₃)、12 h(T₄)、24 h(T₅)、48 h(T₆)PLSP的VAS疼痛评分,评估PLSP程度;记录PCIA泵有效按压次数、补救镇痛例数;记录恶心、呕吐、腹胀等不良反应的发生情况。结果 S组PLSP发生率、PLSP持续时间>10 h比例明显低于C组(P<0.05)。T₃—T₅时S组PLSP程度明显轻于C组(P&l...     

Right stellate ganglion block for treatment of hypertension after cardiopulmonary bypass.

Right stellate ganglion block was performed on 24 patients in whom hypertension developed after cardiopulmonary bypass. Changes in blood pressure, central venous pressure, cardiac output, and heart rate were evaluated. Most patients evidenced a decrease in systolic blood pressure (average, 40 mm Hg) and diastolic blood pressure (average, 19 mm Hg). Systemic vascular resistance was measured in 8 patients, and 7 demonstrated a decrease (average reduction, 6.7 resistance units). Changes in cardiac output were variable. Although stellate ganglion block can be safely performed and, in most patients, markedly reduces systolic blood pressure, the results suggest that other hypotensive agents may be more advantageous in the treatment of hypertension subsequent to coronary artery operation.