Efficacy of Ultrasonography Guided Stellate Ganglion Blockade in the Stroke Patients with Complex Regional Pain Syndrome

Abstract

ObjectiveTo compare the efficacy of ultrasonography guided stellate ganglion block (US-SGB) with that of blind SGB in management of the stroke patients with complex regional pain syndrome (CRPS) type 1.MethodForty-two patients with post-stroke CRPS were randomly assigned to either US-guided SGB (22 patients) or blind SGB group (20 patients). The mean age of US-guided SGB and blind SGB groups was 61.3±5.6 years and 59.1±4.5 years. We performed two blockades at 7-day intervals on the affected side of patients with CRPS. Pain intensity, using a visual analog score (VAS), score of CRPS clinical severity, and the amounts of affected hand swelling with a hand volumeter were assessed before, 2 weeks and 4 weeks after treatment.ResultsIn both groups, VAS and the amount of hand swelling were significantly decreased after 2 weeks and after 4 weeks. Between two groups, VAS difference of US-guided SGB group and that of blind SGB group were 2.61±1.09, 1.88±0.62 at 2 weeks and 3.67±1.03, 3.13±0.62 at 4 weeks, respectively. US-guided SGB group showed more significant improvement in mean change of VAS compared to the blind SGB group (p-value<0.05).ConclusionBoth US-guided SGB and blind SGB techniques were effective in relieving pain in subacute stroke patients with CRPS. US-guided SGB was better in pain relief but has no advantages in reduction of hand swelling in this study.

Ultrasound-Guided Stellate Ganglion Blocks Combined with Pharmacological and Occupational Therapy in Complex Regional Pain Syndrome (CRPS): A Pilot Case SeriesAd Interim

“…The authors observed a mean pain reduction of 3.2 points on the NRS (relative decrease of 62.7%; initial pain level: NRS = 5.1) after 2 weeks in the group receiving ultrasound‐guided SGB, which is similar to the results regarding the spontaneous pain in the present case series. “Blind” SGB led to a mean pain decrease of NRS 2.6 (relative decrease of 50%; initial pain level: NRS = 5.2) [21].…”

“…Transient side effects occurred in 13.5% of the 156 blocks in this case series, of which hoarseness was the most common. Another study observed no adverse side effects in the group receiving SGB under ultrasound guidance (N = 44 SGBs), whereas two patients from the “blind” group SGB experienced hematoma formation on the injected side (N = 40 SGBs) [21]. Van Eijs et al.…”

Effects on hemodynamic variables and echocardiographic parameters after a stellate ganglion block in 15 healthy volunteers

“…Also, LAs can, on the one hand, by exerting an immediate pharmacological effect favorably influence pain and inflammation (Cassuto et al, 2006;Hollmann and Durieux, 2000;Kirillova et al, 2011;Koppert et al, 1998;Pietruck et al, 2003;Ricker, 1924;Spiess, 1906); and, on the other hand, by being delivered to the stellate ganglion favorably influence pain (Kohjitani et al, 2002;Liu et al, 2013;Masuda and Okamoto, 2005;Noma et al, 2013;Peterson et al, 2009;Pfister and Fischer, 2009;Price et al, 1998;Rosenquist and Vrooman, 2013;Salvaggio et al, 2008;Shanthanna, 2013;Wang et al, 2005;Yoo et al, 2012) and inflammation (Liu et al, 2013;Masuda and Okamoto, 2005;Noma et al, 2013;Pfister and Fischer, 2009;Wang et al, 2005;Yoo et al, 2012). The same beneficial effect on pain and inflammation has also been reported for sympathectomy (Leriche, 1958;Noble et al, 2006).…”

Stellate Ganglion Block for Painful Congenital Venous Malformation of the Arm

“…Ultrasound (US)‐guided SGB has recently gained popularity. Its growing use in anesthesia, intensive care, and pain medicine is contributed to by the ubiquitous presence of ultrasound probes in clinical areas and low side effect profile when compared to fluoroscopic or blind techniques and the absence of ionizing radiation . Local anesthetics and corticosteroids are typical agents, and additional adjuvants have been proposed to improve analgesia and prolong its effects …”