Clinical and Physiologic Evaluation of Stellate Ganglion Blockade for Complex Regional Pain Syndrome Type I

Schürmann, Martin; Gradl, Georg; Wizgal, Ingrid; Tutic, Michaela; Moser, Christian; Azad, Shanaz; Beyer, Antje

doi:10.1097/00002508-200103000-00012

Cited by 88 publications

(62 citation statements)

References 22 publications

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“…We and others have shown previously that macro-and microcirculatory changes in the CRPS-I-affected arm resemble the systemic changes in patients with SIRS or sepsis [17][18][19]. Those fi ndings suggest that the profound changes in both macro-and microvascular perfusion in the CRPS-I-affected arm contribute to edema formation and support the hypothesis of an infl ammatory-associated pathogenesis of CRPS.…”

Section: Clinicalsupporting

confidence: 81%

Status of immune mediators in complex regional pain syndrome type I

Schinkel

Kirschner²

2008

Current Science Inc

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Complex regional pain syndrome type I (CRPS-I) can affect an extremity after minor trauma or operation. The pathogenesis of this syndrome is unclear. It has clinical signs of severe local inflammation as a result of an exaggerated inflammatory response, but neurogenic dysregulation is also a contributor. Several studies investigated the role of inflammatory mediators and cytokines thus far; however, the results are heterogeneous and vary between different settings. This review summarizes recent study results that show a clear underlying inflammatory response at the local site, where systemic responses seem to be inconsistent. An induction of CRPS-like symptoms by application of neuroinflammatory mediators was shown recently. Local inflammation is involved in the pathophysiology of CRPS-I. We must expand our knowledge of pathophysiologic mechanisms, and we are still far away from using inflammatory markers in diagnosis and follow-up of CRPS-I.

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Section: Clinicalsupporting

confidence: 81%

Status of immune mediators in complex regional pain syndrome type I

Schinkel

Kirschner²

2008

Current Science Inc

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“…Clinical application of sympathetic blockade has been expanded to patients with hormonal imbalance, psychiatric disorders, and cardiovascular diseases, 27,28 and previous publications have demonstrated that sympathetic blockade can be applied repeatedly without serious adverse effects. 29 We found that monocrotaline treatment led to a significant increase in LF/HF ratio indicating increased sympathovagal balance, whereas SGB attenuated this monocrotaline-induced autonomic balance change. Similar to the previous reports, 13,25 our results also showed that sympathetic hyperactivity is involved in the pathogenesis or progression of PAH, and that the modulation of sympathetic hyperactivity may prevent development or halt the progression of PAH.…”

Section: Discussionmentioning

confidence: 61%

Cervical Ganglion Block Attenuates the Progression of Pulmonary Hypertension via Nitric Oxide and Arginase Pathways

Kim²,

Ryoo³

et al. 2014

Hypertension

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Abstract-It has been recognized that the sympathetic nervous system is activated in pulmonary arterial hypertension (PAH), and abnormal sympathetic hyperactivity leads to worsening of PAH via endothelial dysfunction. The purpose of this study was to examine whether sympathetic ganglion block (SGB) can treat PAH by increasing the availability of nitric oxide (NO). PAH was induced in rats by 50 mg/kg of subcutaneous monocrotaline. After 2 weeks, daily injections of ropivacaine into the left superior cervical ganglion were repeated for 14 days (monocrotaline-SGB group). Monocrotaline group received sham SGB with saline, whereas control group received saline instead of monocrotaline. PAH was evident in monocrotaline group, with right ventricular systolic pressures (47±4 mm Hg) that were higher than those of controls (17±2 mm Hg), whereas SGB significantly attenuated monocrotalineinduced PAH (35±4 mm Hg). The right/left ventricular mass ratios exhibited similar changes to those seen with right ventricular pressures. Heart rate variability showed significantly higher sympathetic activity in the monocrotaline group. Microscopy revealed a higher proportion of muscular arteries with thicker medial walls in the monocrotaline group, which was attenuated by SGB. Monocrotaline induced arginase hyperactivity, which was in turn decreased by SGB-induced endothelial NO synthase activation. SGB restored monocrotaline-induced hypoactivity of superoxide dismutase. In conclusion, SGB could suppress PAH and the remodeling of pulmonary arteries via inactivation of arginase and reciprocal elevation of NO bioavailability, thus attenuating disproportionate hyperactivation of the have been reported to attenuate the severity of symptoms and slow the progression of cardiovascular diseases including coronary artery disease, heart failure, and arrhythmias. According to the previous reports, there is a possibility that direct sympathetic nerve blocks are effective in patients with myocardial ischemia or systemic hypertension. 17,19 Given the relationship between sympathetic nervous system hyperactivity and endothelial dysfunction in patients with PAH, blockade of sympathetic hyperactivity may improve vascular reactivity by preserving endothelial function. To date, however, there is limited amount of data on the therapeutic effects of sympathetic ganglion block (SGB) on PAH. The purpose of the present study is to assess the therapeutic effects of SGB in a monocrotaline-induced PAH rat model. In parallel, we investigated whether SGB could attenuate the changes in arginase and NO bioavailability, as well as oxidative stress caused by monocrotaline. MethodsDetailed methods about animal preparation, experimental design, SGB, heart rate variability, hemodynamic analysis, right ventricular mass, pulmonary vessel morphometry, and NO (synthase)/arginase/ cGMP/oxidative stress assay are described in the online-only Data Supplement. Results Right Ventricular Systolic Pressure and Right Ventricular/Left Ventricular Mass RatioRight ventricular systolic pr...

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“…Stellate Ganglion Block (SGB) is an effective technique and may be used to manage upper extremities pain due to chronic regional pain syndrome (CRPS) [1,2]. CRPS is a painful and disabling syndrome with physical changes in the affected extremity.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Stellate Ganglion Block Under Fuoroscopy or Ultrasound Guidance in Upper Extremity CRPS

Imani

Karim

Rahimzadeh

et al. 2016

JCDR

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Clinical and Physiologic Evaluation of Stellate Ganglion Blockade for Complex Regional Pain Syndrome Type I

Abstract: Clinical investigation is not reliable in the assessment of stellate ganglion blockade. Proof of sympathetically maintained pain based on pain relief after stellate ganglion blockade is not conclusive.

Cited by 88 publications

References 22 publications

Status of immune mediators in complex regional pain syndrome type I

Status of immune mediators in complex regional pain syndrome type I

Cervical Ganglion Block Attenuates the Progression of Pulmonary Hypertension via Nitric Oxide and Arginase Pathways

Effectiveness of Stellate Ganglion Block Under Fuoroscopy or Ultrasound Guidance in Upper Extremity CRPS

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