Journal of Yeungnam Medical Science

Original Article

Comparison of ultrasound-guided stellate ganglion block at 6th and 7th cervical vertebrae using the lateral paracarotid out-of-plane approach for sympathetic blockade in the upper extremity: Jongyoon Baek, Bum Soo Kim, Hwarim Yu, Hyuckgoo Kim, Chaeseok Lim, Sun Ok Song; Yeungnam Univ J Med. 2018;35(2):199-204. Published online December 31, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.2.199

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Background
The authors have performed ultrasound-guided stellate ganglion block (SGB) in our clinic using a lateral paracarotid approach at the level of the 6th cervical vertebra (C6). Although SGB at C6 is a convenient and safe method, there are ongoing concerns about the weak effect of sympathetic blockade in the ipsilateral upper extremity. Therefore, ultrasound-guided SGB was attempted using a lateral paracarotid approach at the level of the 7th cervical vertebra (C7). This prospective study aimed to compare changes in skin temperature after SGB was performed at C6 and C7, and to introduce a lateral paracarotid approach for SGB.
Methods
Thirty patients underwent SGB twice: once at C6 and once at C7. For every SGB, the skin temperature of the patient’s hypothenar area was measured for 15 min at 1-min intervals. Skin temperatures before and after SGB and side effects were compared between C6 and C7 groups.
Results
The temperature of the upper extremity increased after SGB was performed at C6 and C7. There were significant differences between mean pre-SGB and the largest increases in post-SGB temperatures (0.50±0.38℃ and 1.41±0.68℃ at C6 and C7, respectively; p<0.05). Significantly increased post-SGB temperatures (difference >1℃) were found in 5/30 (16.7%) and 24/30 (80%) cases for C6 and C7, respectively (p<0.05). There were no significant differences in side effects between SGB performed at C6 or C7 (p>0.05).
Conclusion
The lateral paracarotid approach using out-of-plane needle insertion for ultrasound-guided SGB performed at C7 was feasible and more effective at elevating skin temperature in the upper extremity than SGB at C6.

Citations

Citations to this article as recorded by

The usefulness of stellate ganglion block with ultrasound-guided lateral paracarotid approach in ventricular arrhythmias: A case series
Hansung Ryu, Hyuckgoo Kim
Saudi Journal of Anaesthesia.2024; 18(2): 276. CrossRef
Establishment of ultrasound-guided stellate ganglion block in rats
Shi-zhu Lin, Lu Chen, Yi-jie Tang, Cheng-jie Zheng, Peng Ke, Meng-nan Chen, Hai-xing Wu, Yu Chen, Liang-cheng Qiu, Xiao-dan Wu, Kai Zeng
Frontiers in Neuroscience.2023;[Epub] CrossRef
Magnetic resonance imaging validation of medial transthyroid ultrasound‐guided stellate ganglion block: A pilot study
Boo Young Chung, Christian Holfelder, Robert E. Feldmann, Dieter Kleinboehl, Raoul C. Raum, Justus Benrath
Pain Practice.2022; 22(3): 329. CrossRef
Prolonged blockade of the cervical sympathetic nerve by stellate ganglion block accelerates therapeutic efficacy in trigeminal neuropathy
Kazune Kawabata, Teppei Sago, Tsuneto Oowatari, Shunji Shiiba
Journal of Oral Science.2022; 64(1): 6. CrossRef
Comment on an Article by Aleanakian et al. Titled “Effectiveness, Safety, and Predictive Potential in Ultrasound‐Guided Stellate Ganglion Blockades (SGB) for the Treatment of Sympathetically Maintained Pain”
Pratibha Singh, Anil Agarwal, Chetna Shamshery
Pain Practice.2021; 21(5): 602. CrossRef

Review

Adjuvant medications to local anesthetics in nerve blockade: Deok Hee Lee; Yeungnam Univ J Med. 2017;34(2):161-168. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.161

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Abstract PDF: Peripheral nerve blocks are commonly used for surgical anesthesia, postoperative analgesia, and to reduce opioid requirements. Although these blocks have traditionally been carried out using local anesthetics, single-injection techniques can be short-lived and limited by the relatively brief duration of action of currently available local anesthetics. Increasing the dose or concentration of local anesthetics may prolong the duration of analgesia, but may also increase the risk such as unwanted motor weakness or systemic toxicity of local anesthetics. Numerous adjuvant medications have been added to local anesthetics to prolong the durations of anesthesia and analgesia achieved by peripheral nerve blocks, and currently, a number of different adjuvants are used to improve quality of the block. This article will review the several nerve block adjuvants used in combination with local anesthetics to provide blockade of peripheral nerves in clinical practice, describing the rationale for their use in peripheral nerve blocks, and the evidence for their effectiveness.

Case Report

Exacerbation of spasticity in ipsilateral shoulder after right brachial plexus block in a patient with right hemiplegia.: Sang Jin Park, Jong Yoon Baek; Yeungnam Univ J Med. 2015;32(1):22-25. Published online June 30, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.1.22

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Abstract PDF: Spasticity is a common impairment in patients with central nervous system disease. Clinical observation has demonstrated that spasticity can be aggravated by various factors such as emotional state as well as noxious stimuli. A 51-year-old male patient was scheduled for arteriovenous fistula surgery. He had right hemiplegia including motor weakness and spasticity. It was decided that the surgery would be performed under an axillary brachial plexus block (BPB). He appeared nervous when blockade was terminated. The spasticity of the right shoulder increased after ipsilateral BPB. However, when we administered sedative drugs and performed interscalene BPB 2 days later, spasticity did not occur. Exacerbation of spasticity might be evoked by an anxious emotional state. Thus, it seems to be good to consider removing of anxiety and using an appropriate approach when it is tried to perform nerve blocks in individuals with spasticity.

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