Cardiac arrest following stellate ganglion block performed under ultrasound guidance

Rastogi, Shivani; Tripathi, Shiva

doi:10.1111/j.1365-2044.2010.06487.x

Cited by 20 publications

(14 citation statements)

References 4 publications

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“…The patient was successfully resuscitated without sequelae and went on to complete his series of 10 SGNBs. Rastogi and Tripathi26 described a patient who underwent a left-sided, ultrasound-guided stellate block for facial pain. After appropriate needle positioning, 10 mL 0.5% bupivacaine was injected; this resulted in seizures and was followed by cardiac arrest.…”

Section: Resultsmentioning

confidence: 99%

Complications associated with stellate ganglion nerve block: a systematic review

Goel

Patwardhan

Ibrahim

et al. 2019

Reg Anesth Pain Med

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Stellate ganglion nerve blockade (SGNB) is a vital tool in our armamentarium for the treatment of various chronic pain syndromes. SGNB can be performed using the traditional landmark-based approach, or with image guidance using either fluoroscopy or ultrasound. In this review, we systematically analyzed reported SGNB-related complications between 1990 and 2018. Seven databases were queried for SGNB between January 1, 1990 and November 27, 2018. Search results of the complications associated with SGNB were reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Out of a total of 1909 articles, 67 articles met our inclusion criteria, yielding 260 cases with adverse events. In 134 of the 260 (51.5%) cases, SGNB was performed with image guidance. Sixty-four (24.6%) and 70 (26.9%) of the complication cases reported the use of ultrasound and fluoroscopy guidance, respectively. One hundred and seventy-eight (68.4%) patients had medication-related or systemic side effects, and 82 (31.5%) had procedure-related or local side effects. There was one report of death due to massive hematoma leading to airway obstruction. There was one case report of quadriplegia secondary to pyogenic cervical epidural abscess and discitis following an SGNB. Complications following SGNB have been reported with both landmark-based techniques and with imaging guidance using fluoroscopy or ultrasound. In our systematic review, most adverse events that were reported occurred during or shortly after SGNB. Vigilance, American Society of Anesthesiologists standard monitors for conscious sedation, and accessibility to resuscitation equipment are vital to the safe performance of SGNB.

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Section: Resultsmentioning

confidence: 99%

Complications associated with stellate ganglion nerve block: a systematic review

Goel

Patwardhan

Ibrahim

et al. 2019

Reg Anesth Pain Med

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“…Nevertheless, complications may occur with ultrasound-guided blocks. Rastogui et al [16] reported cardiac arrest following ultrasound-guided SGB.…”

Section: Discussionmentioning

confidence: 99%

The importance of perfusion index monitoring in evaluating the efficacy of stellate ganglion blockage treatment in Raynaud’s disease

Şahin

Kılıç²,

Aksoy

et al. 2018

Libyan Journal of Medicine

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Stellate ganglion blockage (SGB) is a method used for treating Raynaud’s phenomenon (RP). This study primarily aimed to determine whether the perfusion index (PI) can be used an alternative to Horner’s signs in evaluating the efficacy of SGB in patients diagnosed with RP. In a total of 40 patients, aged 18–65 years and diagnosed with primary RP, SGB was applied for 5 days on the same side with the 2-finger method, using 6 mL of 5% levobupivacaine at the 7th cervical vertebra level. The PI values were recorded from the distal end of the 2nd finger of the upper extremity on the side applied with the block at baseline and at 5, 15, 30, 60 and 120 min. The onset time of Horner findings was recorded. The PI values and visual analogue scale (VAS) pain scores were recorded pre-treatment and after 2 weeks.When the PI values of the 40 patients were examined, a 62.7% increase was observed from baseline to the first session at 5 min (p < 0.05). When all sessions were evaluated, a statistically significant increase was determined in the PI values measured at 5, 15, 30, 60 and 120 min compared with the baseline PI values. There was a statistically significant decrease in the post-treatment VAS pain scores and a statistically significant increase in the post-treatment PI values (p < 0.05). By eliminating peripheral vasospasm with the application of SGB in patients with RP, the distal artery blood flow and PI are increased. PI measurement is a more objective method and therefore could be used as an alternative to Horner findings in evaluating the success of SGB. PI is a non-invasive and simple measurement and also an earlier indicator in evaluating the success of SGB than Horner’s signs.

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“…Procedural success and risk reduction during ultrasound guided interventions are determined by familiarity with anatomy, technical skills, and needle trajectory planning during a scout scan (11). Cardiac arrest, secondary to intravascular injection, has been reported following ultrasound guided stellate ganglion blocks (12). This brings to question the infallibility of ultrasound guidance, promotes retrospection and an understanding of its limitations.…”

Section: Introductionmentioning

confidence: 99%

Transient Neuronal Injury Followed by Intravascular Injection During an Ultrasound Guided Stellate Ganglion Block

Shankar¹,

Simhan

2012

Anesth Pain

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Ultrasound guidance for pain interventions is becoming increasing recognized as a useful imaging tool. One of the common interventions where it is gaining wider acceptance is during the performance of a stellate ganglion block. The following is a unique report where intravascular and neuronal injury occurred during the performance of an ultrasound guided stellate ganglion block followed by dysphagia. 41 year old male, with a diagnosis of complex regional pain syndrome, was referred to our clinic for further management. He underwent a diagnostic ultrasound guided stellate ganglion block after having tried conservative therapies. The stellate ganglion block provided him with complete pain relief for over five weeks. During a subsequent therapeutic stellate ganglion block, performed by an experienced pain medicine fellow with more than 50 ultrasound guided proceduresclinician, the patient developed a transient injury to the brachial plexus upon needle entry. Subsequent redirection and injection of an ml of injectate resulted in an intravascular injection producing tinnitus. After the tinnitus decreased, he underwent another stellate block using an out of plane approach without any further complications. Two days later, he reported chest and throat discomfort which resolved over the next few days possibly due to a retropharyngeal hematoma. He declined further interventions and was subsequently managed with 3 tablets of oxycodone a day. This report highlights the importance of vigilance and meticulous planning during the performance of ultrasound guided pain interventions.

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Cardiac arrest following stellate ganglion block performed under ultrasound guidance

Cited by 20 publications

References 4 publications

Complications associated with stellate ganglion nerve block: a systematic review

Complications associated with stellate ganglion nerve block: a systematic review

The importance of perfusion index monitoring in evaluating the efficacy of stellate ganglion blockage treatment in Raynaud’s disease

Transient Neuronal Injury Followed by Intravascular Injection During an Ultrasound Guided Stellate Ganglion Block

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