Cargando…

Evaluation of new approach to ultrasound guided stellate ganglion block

BACKGROUND: 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...

Descripción completa

Detalles Bibliográficos
Autores principales: Ghai, Anju, Kaushik, Teshi, Kundu, Zile Singh, Wadhera, Sarthak, Wadhera, Raman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4799607/
https://www.ncbi.nlm.nih.gov/pubmed/27051366
http://dx.doi.org/10.4103/1658-354X.168815
_version_ 1782422382417281024
author Ghai, Anju
Kaushik, Teshi
Kundu, Zile Singh
Wadhera, Sarthak
Wadhera, Raman
author_facet Ghai, Anju
Kaushik, Teshi
Kundu, Zile Singh
Wadhera, Sarthak
Wadhera, Raman
author_sort Ghai, Anju
collection PubMed
description BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: NPIS showed a statistically significant decrease from baseline at 30 min, which was sustained till 3(rd) month. The rise in axillary temperature after the block was statistically significant, which was sustained till 2(nd) 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. CONCLUSION: 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.
format Online
Article
Text
id pubmed-4799607
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-47996072016-04-05 Evaluation of new approach to ultrasound guided stellate ganglion block Ghai, Anju Kaushik, Teshi Kundu, Zile Singh Wadhera, Sarthak Wadhera, Raman Saudi J Anaesth Original Article BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: NPIS showed a statistically significant decrease from baseline at 30 min, which was sustained till 3(rd) month. The rise in axillary temperature after the block was statistically significant, which was sustained till 2(nd) 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. CONCLUSION: 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. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC4799607/ /pubmed/27051366 http://dx.doi.org/10.4103/1658-354X.168815 Text en Copyright: © Saudi Journal of Anaesthesia http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Ghai, Anju
Kaushik, Teshi
Kundu, Zile Singh
Wadhera, Sarthak
Wadhera, Raman
Evaluation of new approach to ultrasound guided stellate ganglion block
title Evaluation of new approach to ultrasound guided stellate ganglion block
title_full Evaluation of new approach to ultrasound guided stellate ganglion block
title_fullStr Evaluation of new approach to ultrasound guided stellate ganglion block
title_full_unstemmed Evaluation of new approach to ultrasound guided stellate ganglion block
title_short Evaluation of new approach to ultrasound guided stellate ganglion block
title_sort evaluation of new approach to ultrasound guided stellate ganglion block
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4799607/
https://www.ncbi.nlm.nih.gov/pubmed/27051366
http://dx.doi.org/10.4103/1658-354X.168815
work_keys_str_mv AT ghaianju evaluationofnewapproachtoultrasoundguidedstellateganglionblock
AT kaushikteshi evaluationofnewapproachtoultrasoundguidedstellateganglionblock
AT kunduzilesingh evaluationofnewapproachtoultrasoundguidedstellateganglionblock
AT wadherasarthak evaluationofnewapproachtoultrasoundguidedstellateganglionblock
AT wadheraraman evaluationofnewapproachtoultrasoundguidedstellateganglionblock