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Ultrasound imaging is an ideal tool for stellate ganglion block (SGB) due to clarity, portability, lack of radiation, and low cost.
This original
research article deals with using the lateral approach at C 7 vertebral level
helpful in complex regional pain syndrome of the upper limb in patients. The
addition of steroid to the local anesthetic mixture sustained the effect in
pain relief.
Ultrasound
imaging is an ideal tool for stellate ganglion block (SGB) due to clarity,
portability, lack of radiation, and low cost. Ultrasound guided anterior
approach requires the application of pressure to the anterior neck and is
associated with more risk of injury to inferior thyroid artery, vertebral
artery, and esophagus. The lateral approach does not interfere with nerve or
vascular structures. Blockade at the C 6 vertebral level results in more
successful sympathetic blockade of the head and neck with less sympathetic
blockade of the upper extremity compared to sympathetic blockade at C 7
vertebral level, which produces successful sympathetic blockade of upper
extremity. This is helpful in patients of complex regional pain syndrome of the
upper limb. Hence, we conducted a study using the lateral approach at C 7
level.
Ultrasound guided
SGBs using lateral in-plane technique at C 7 level were given in 20 patients
suffering from chronic pain patients of upper extremity, head, and neck using 4
ml of 0.25% bupivacaine and 1 ml of 40 mg triamcinolone. The patients were
assessed for a numeric pain intensity score (NPIS), the rise in axillary temperature,
the range of motion of joints of upper extremity, and resolution of edema at
various time intervals up to 3 months.
NPIS showed a
statistically significant decrease from baseline at 30 min, which was sustained
till 3rd month. The rise in axillary temperature after the block was
statistically significant, which was sustained till 2nd week. The edema score
decreased significantly at all-time intervals (P ≤ 0.001). The restriction of
motion in all joints of upper limb decreased from 13 to 3 patients.
There is a
significant variation in the anatomy of stellate ganglion at the level of C 6
and C 7. Ultrasound guided lateral approach increases the efficacy of SGB by
deposition of drug subfascially with real-time imaging.
Saudi J Anaesth. 2016 Apr-Jun;10(2):161-7
Evaluation of new approach to ultrasound guided stellate ganglion block
Anju Ghai et al.
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