Skip to main content

Advertisement

SpringerLink
Log in

The efficacy of ultrasound-guided stellate ganglion block in alleviating postoperative pain and ventricular arrhythmias and its application prospects

  • Review Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Stellate ganglion block (SGB) has been applied in clinic for almost a century as a therapeutic procedure to alleviate pain-related syndromes and vascular deficits in the upper extremities. A great number of causative side effects and complications due to technological insufficiency and anatomical variations called for the popularity of ultrasound-guided SGB which has made tremendous contribution for clinical diagnosis and therapy, primarily in postoperative pain and cardiac and vascular disorders. This work was aimed at systematically summarizing the current clinical application of ultrasound-guided SGB and putting forward the potential prospective application in future. By searching ultrasound-guided SGB-related works on PubMed database, we mainly elucidated the analgesic effect of preoperative SGB in patients undergoing surgical procedures and substantial reduction in patients with ventricular arrhythmias. The volume of local anesthetics used in ultrasound-guided SGB has been diminished in the recent few years’ investigations and successful operation of ultrasound-guided SGB could be achieved with minimal safe volume of local anesthetics. This invasive and safe procedure shows vast potential for future development in clinical treatment for autonomic nervous system and autoimmune disorders. We also put forward hypothesis that ultrasound-guided SGB could be applied combined with controlled hypotension to reduce the intraoperative complications in orthopedic surgery such as insufficiency of cerebral blood flow and reflexive tachycardia. Thus, it is of vital essence to improve the professional skills of physicians for the high rate of success and explore more effective measures which could enhance therapeutic effects when combined with ultrasound-guided SGB in alleviating misery of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cai C, Dai MY, Tian Y, Zhang P, Wittwer ED, Rho RH, Kapa S, McLeod CJ, Mulpuru SK, Lee HC, Ackerman MJ, Asirvatham SJ, Munger TM, Chen ML, Friedman PA, Cha YM (2019) Electrophysiologic effects and outcomes of sympatholysis in patients with recurrent ventricular arrhythmia and structural heart disease. J Cardiovasc Electrophysiol 30(9):1499–1507

    Article  PubMed  Google Scholar 

  2. Kumar A, Sinha C, Kumar A, Sinha AK (2017) Ultrasound-guided stellate ganglion block for resistant ventricular tachycardia. Saudi J Anaesth 11(3):372–373

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yoo Y, Lee CS, Kim YC, Moon JY, Finlayson RJ (2019) A randomized comparison between 4, 6 and 8 mL of local anesthetic for ultrasound-guided stellate ganglion block. J Clin Med. 8(9).

  4. Makharita MY, Amr YM, El-Bayoumy Y (2012) Effect of early stellate ganglion blockade for facial pain from acute herpes zoster and incidence of postherpetic neuralgia. Pain Physician 15(6):467–474

    PubMed  Google Scholar 

  5. Park JH, Min YS, Chun SM, Seo KS (2015) Effects of stellate ganglion block on breast cancer-related lymphedema: comparison of various injectates. Pain Physician 18(1):93–99

    PubMed  Google Scholar 

  6. Wulf H, Maier C, Schele HA, Wabbel W (1991) Plasma concentration of bupivacaine after stellate ganglion blockade. Anesth Analg 72(4):546–548

    Article  CAS  PubMed  Google Scholar 

  7. Lu F, Tian J, Dong J, Zhang K (2019) Tonic-clonic seizure during the ultrasound-guided stellate ganglion block because of an injection into an unrecognized variant vertebral artery: a case report. Medicine (Baltimore) 98(48):e18168

    Article  Google Scholar 

  8. Kapral S, Krafft P, Gosch M, Fleischmann D, Weinstabl C (1995) Ultrasound imaging for stellate ganglion block: direct visualization of puncture site and local anesthetic spread. A pilot study. Reg Anesth 20(4):323–328

    CAS  PubMed  Google Scholar 

  9. Narouze S (2014) Ultrasound-guided stellate ganglion block: safety and efficacy. Curr Pain Headache Rep 18(6):424

    Article  PubMed  Google Scholar 

  10. Barha CK, Nagamatsu LS, Liu-Ambrose T (2016) Basics of neuroanatomy and neurophysiology. Handb Clin Neurol 138:53–68

    Article  CAS  PubMed  Google Scholar 

  11. Pearce JM (2009) Henry Gray's Anatomy. Clin Anat 22(3):291–295

    Article  CAS  PubMed  Google Scholar 

  12. Hogan QH, Erickson SJ (1992) MR imaging of the stellate ganglion: normal appearance. AJR Am J Roentgenol 158(3):655–659

    Article  CAS  PubMed  Google Scholar 

  13. Raut MS, Maheshwari A (2018) Stellate ganglion block: important weapon in the anesthesiologists’ armamentarium. J Cardiothorac Vasc Anesth 32(2):e36–e37

    Article  PubMed  Google Scholar 

  14. Takai Y, Yamamoto-Mitani N, Abe Y, Suzuki M (2015) Literature review of pain management for people with chronic pain. Jpn J Nurs Sci 12(3):167–183

    Article  PubMed  Google Scholar 

  15. Lee MH, Kim KY, Song JH, Jung HJ, Lim HK, Lee DI, Cha YD (2012) Minimal volume of local anesthetic required for an ultrasound-guided SGB. Pain Med 13(11):1381–1388

    Article  PubMed  Google Scholar 

  16. Kim MK, Yi MS, Park PG, Kang H, Lee JS, Shin HY (2018) Effect of stellate ganglion block on the regional hemodynamics of the upper extremity: a randomized controlled trial. Anesth Analg 126(5):1705–1711

    Article  PubMed  Google Scholar 

  17. Erickson SJ, Hogan QH (1993) CT-guided injection of the stellate ganglion: description of technique and efficacy of sympathetic blockade. Radiology. 188(3):707–709

    Article  CAS  PubMed  Google Scholar 

  18. Hogan QH, Erickson SJ, Haddox JD, Abram SE (1992) The spread of solutions during stellate ganglion block. Reg Anesth 17(2):78–83

    CAS  PubMed  Google Scholar 

  19. Narouze S, Vydyanathan A, Patel N (2007) Ultrasound-guided stellate ganglion block successfully prevented esophageal puncture. Pain Physician 10(6):747–752

    Article  PubMed  Google Scholar 

  20. Sdrulla A, Chen G (2016) Minimally invasive procedures for neuropathic pain. Pain Manag 6(2):103–109

    Article  PubMed  Google Scholar 

  21. Wang J, Chen Z (2019) Neuromodulation for pain management. Adv Exp Med Biol 1101:207–223

    Article  CAS  PubMed  Google Scholar 

  22. Witt CM, Bolona L, Kinney MO, Moir C, Ackerman MJ, Kapa S, Asirvatham SJ, McLeod CJ (2017) Denervation of the extrinsic cardiac sympathetic nervous system as a treatment modality for arrhythmia. Europace. 19(7):1075–1083

    Article  PubMed  Google Scholar 

  23. Ouyang R, Li X, Wang R, Zhou Q, Sun Y, Lei E. (2020) Effect of ultrasound-guided right stellate ganglion block on perioperative atrial fibrillation in patients undergoing lung lobectomy: a randomized controlled trial. Rev Bras Anestesiol

  24. De Ferrari GM, Dusi V, Spazzolini C, Bos JM, Abrams DJ, Berul CI et al (2015) Clinical management of catecholaminergic polymorphic ventricular tachycardia: the role of left cardiac sympathetic denervation. Circulation. 131(25):2185–2193

    Article  PubMed  Google Scholar 

  25. Yamaguchi N, Yamakawa K, Rajendran PS, Takamiya T, Vaseghi M (2018) Antiarrhythmic effects of vagal nerve stimulation after cardiac sympathetic denervation in the setting of chronic myocardial infarction. Heart Rhythm 15(8):1214–1222

    Article  PubMed  PubMed Central  Google Scholar 

  26. Xie X, Visweswaran R, Guzman PA, Smith RM, Osborn JW, Tolkacheva EG (2011) The effect of cardiac sympathetic denervation through bilateral stellate ganglionectomy on electrical properties of the heart. Am J Physiol Heart Circ Physiol 301(1):H192–H199

    Article  CAS  PubMed  Google Scholar 

  27. Fudim M, Qadri YJ, Waldron NH, Boortz-Marx RL, Ganesh A, Patel CB, Podgoreanu MV, Sun AY, Milano CA, Tong BC, Harpole DH Jr, Mathew JP, Piccini JP (2020) Stellate ganglion blockade for the treatment of refractory ventricular arrhythmias. JACC Clin Electrophysiol 6(5):562–571

    Article  PubMed  Google Scholar 

  28. Gadhinglajkar S, Sreedhar R, Unnikrishnan M, Namboodiri N (2013) Electrical storm: role of stellate ganglion blockade and anesthetic implications of left cardiac sympathetic denervation. Indian J Anaesth 57(4):397–400

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wu CN, Wu XH, Yu DN, Ma WH, Shen CH, Cao Y (2020) A single-dose of stellate ganglion block for the prevention of postoperative dysrhythmias in patients undergoing thoracoscopic surgery for cancer: a randomised controlled double-blind trial. Eur J Anaesthesiol 37(4):323–331

    Article  PubMed  Google Scholar 

  30. Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78(5):606–617

    Article  CAS  PubMed  Google Scholar 

  31. Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, Cohen SR, Wu CL (2006) Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg 102(1):248–257

    Article  PubMed  Google Scholar 

  32. Sedighinejad A, Haghighi M, Naderi Nabi B, Rahimzadeh P, Mirbolook A, Mardani-Kivi M, Nekufard M, Biazar G (2014) Magnesium sulfate and sufentanil for patient-controlled analgesia in orthopedic surgery. Anesth Pain Med 4(1):e11334

    PubMed  PubMed Central  Google Scholar 

  33. McDonnell JG, Finnerty O, Laffey JG (2011) Stellate ganglion blockade for analgesia following upper limb surgery. Anaesthesia. 66(7):611–614

    Article  CAS  PubMed  Google Scholar 

  34. Imani F, Hemati K, Rahimzadeh P, Kazemi MR, Hejazian K (2016) Effectiveness of stellate ganglion block under fuoroscopy or ultrasound guidance in upper extremity CRPS. J Clin Diagn Res. 10(1):Uc09-12.

  35. Kumar N, Thapa D, Gombar S, Ahuja V, Gupta R (2014) Analgesic efficacy of pre-operative stellate ganglion block on postoperative pain relief: a randomised controlled trial. Anaesthesia. 69(9):954–660

    Article  CAS  PubMed  Google Scholar 

  36. Jin F, Li XQ, Tan WF, Ma H, Fang B, Tian AY, Lu HW (2018) Effects of ultrasound-guided stellate-ganglion block on sleep and regional cerebral oxygen saturation in patients undergoing breast cancer surgery: a randomized, controlled, double-blinded trial. J Clin Monit Comput 32(5):855–862

    Article  PubMed  Google Scholar 

  37. Walid T, Mondher BA, Mohamed Anis L, Mustapha F (2012) A case of Horner's syndrome following ultrasound-guided infraclavicular brachial plexus block. Case Rep Anesthesiol 2012:125346

    PubMed  PubMed Central  Google Scholar 

  38. Rodríguez J, Bárcena M, Alvarez J (2003) Restricted infraclavicular distribution of the local anesthetic solution after infraclavicular brachial plexus block. Reg Anesth Pain Med 28(1):33–36

    Article  PubMed  CAS  Google Scholar 

  39. El-Boghdadly K, Chin KJ (2016) Local anesthetic systemic toxicity: continuing professional development. Can J Anaesth 63(3):330–349

    Article  PubMed  Google Scholar 

  40. Mahli A, Coskun D, Akcali DT (2002) Aetiology of convulsions due to stellate ganglion block: a review and report of two cases. Eur J Anaesthesiol 19(5):376–380

    Article  CAS  PubMed  Google Scholar 

  41. Bloc S, Ecoffey C, Dhonneur G (2008) Controlling needle tip progression during ultrasound-guided regional anesthesia using the hydrolocalization technique. Reg Anesth Pain Med 33(4):382–383

    Article  PubMed  Google Scholar 

  42. Yeo J, Jeon Y (2015) Effects of stellate ganglion block on sedation as assessed by bispectral index in normal healthy volunteers. Pain Physician 18(2):173–178

    PubMed  Google Scholar 

  43. Jung G, Kim BS, Shin KB, Park KB, Kim SY, Song SO (2011) The optimal volume of 0.2% ropivacaine required for an ultrasound-guided stellate ganglion block. Korean J Anesthesiol 60(3):179–184

    Article  PubMed  PubMed Central  Google Scholar 

  44. Heinig B, Koch A, Wollina U (2018) Palmar hyperhidrosis treated by noninvasive ultrasound stellate ganglion block. Wien Med Wochenschr 168(9-10):250–253

    Article  PubMed  Google Scholar 

  45. Woo A, Tharakan L, Vargulescu R (2015) Stellate ganglion block for painful congenital venous malformation of the arm. Pain Pract 15(6):E65–E68

    Article  PubMed  Google Scholar 

  46. Punj J (2019) Multiple bilateral ultrasound-guided stellate ganglion blocks to treat acute vasculitis in a recently diagnosed patient of systemic lupus erythematosus. Indian J Anaesth 63(10):851–855

    Article  PubMed  PubMed Central  Google Scholar 

  47. Peng K, Zhang J, Chen WR, Liu HY, Ji FH (2017) Ultrasound-guided stellate ganglion block improves gastrointestinal function after thoracolumbar spinal surgery. Clin Ther 39(11):2322–2330

    Article  PubMed  Google Scholar 

  48. Bantel C, Trapp S (2011) The role of the autonomic nervous system in acute surgical pain processing - what do we know? Anaesthesia. 66(7):541–544

    Article  CAS  PubMed  Google Scholar 

  49. Hernández-Porras BC, Plancarte-Sánchez R, Alarcón-Barrios S, Sámano-García M (2017) Complex regional pain syndrome: A review. Cir Cir 85(4):366–374

    PubMed  Google Scholar 

  50. Jones GP, Tripathi SS (2014) Successful use of stellate ganglion block and a new centrally acting analgesic with dual mode of action in a resistant temporomandibular joint pain. BMJ Case Rep 2014

  51. Rahimzadeh P, Mahmoudi K, Khodaverdi M, Faiz SHR (2020) Effects of ultrasound guided ganglion stellate blockade on intraoperative and postoperative hemodynamic responses in laparoscopic gynecologic surgery. Wideochir Inne Tech Maloinwazyjne 15(2):351–357

    PubMed  Google Scholar 

  52. Ye M, Zhou HS, Wei Y, Liu F (2021) Inadvertent mental excitement after ultrasound-guided bilateral thoracic paravertebral block: a case report. Ibrain 7(1):28–32 http://www.ibrain.org.cn/front/Allvolumesissues/74.shtml

    Google Scholar 

  53. Thapa D, Dhiman D, Ahuja V, Gombar S, Gupta RK (2018) Tramadol sparing effect of dexmedetomidine as an adjuvant with lignocaine in preoperative stellate ganglion block for postoperative pain relief following upper limb surgeries. Br J Pain 12(1):26–34

    Article  PubMed  Google Scholar 

  54. Ghai A, Kaushik T, Kundu ZS, Wadhera S, Wadhera R (2016) Evaluation of new approach to ultrasound guided stellate ganglion block. Saudi J Anaesth 10(2):161–167

    Article  PubMed  PubMed Central  Google Scholar 

  55. Pu S, Chen J, Gu X, Xu Y, Wu J, Lv Y, du D (2018) Effects of ultrasound-guided stellate ganglion block on cervical vascular blood flow: study protocol for a randomized controlled trial. Trials. 19(1):426

    Article  PubMed  PubMed Central  Google Scholar 

  56. Gillespie R, Shishani Y, Streit J, Wanner JP, McCrum C, Syed T, Haas A, Gobezie R (2012) The safety of controlled hypotension for shoulder arthroscopy in the beach-chair position. J Bone Joint Surg Am 94(14):1284–1290

    Article  PubMed  Google Scholar 

  57. Tran A, Yates J, Lau A, Lampron J, Matar M (2018) Permissive hypotension versus conventional resuscitation strategies in adult trauma patients with hemorrhagic shock: a systematic review and meta-analysis of randomized controlled trials. J Trauma Acute Care Surg 84(5):802–808

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was financially supported by the National Natural Science Foundation of China (No. 81960214).

Author information

Author notes

  1. Song Wen and Li Chen are equal first authors.

Authors and Affiliations

  1. Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, 550000, Guizhou, China

    Song Wen, Liang Dong, Zhao-Qiong Zhu & Liu-Lin Xiong

  2. Institute of Neurological Disease, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Li Chen & Ting-Hua Wang

  3. Animal Zoology Department, Institute of Neuroscience, Kunming Medical University, Kunming, 650031, Yunnan, China

    Ting-Hua Wang

Authors
  1. Song Wen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ting-Hua Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liang Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhao-Qiong Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Liu-Lin Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Zhao-Qiong Zhu or Liu-Lin Xiong.

Ethics declarations

Ethical approval

Not applicable.

Conflict of interest

None

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Ting-Hua Wang is one of the co-authors.

Zhao-Qiong Zhu and Liu--Lin Xiong are co-corresponding.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wen, S., Chen, L., Wang, TH. et al. The efficacy of ultrasound-guided stellate ganglion block in alleviating postoperative pain and ventricular arrhythmias and its application prospects. Neurol Sci 42, 3121–3133 (2021). https://doi.org/10.1007/s10072-021-05300-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-021-05300-4

Keywords

Search

Navigation