Ganglionic Local Opioid Application (GLOA) for Treatment of Chronic Headache and Facial Pain

Harris, Clinton L.; Hamid, Basem; Rosenquist, Richard W.; Schultz-Stubner, Sebastian H.W.

doi:10.1016/j.rapm.2006.03.011

Cited by 12 publications

(6 citation statements)

References 12 publications

(8 reference statements)

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“…in 2006 reported profound pain relief following local application with buprenorphine at the stellate ganglion for head and face pain, supporting the presence of endogenous opioids on sympathetic ganglion. [16] For long-term effects unlike neurolysis of the lumbar sympathetic chain, many clinicians have avoided neurolysis of the stellate ganglion for the risk of producing permanent Horner’s or complications due to spread of neurolytic solution. [1] For prolonged effects, addition of 40 mg of triamcinalone or fentanyl has been advocated.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of stellate ganglion block with an adjuvant ketamine for peripheral vascular disease of the upper limbs

2010

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Stellate ganglion block (STGB) is commonly indicated in painful conditions like reflex sympathetic dystrophy, malignancies of head and neck, Reynaud’s disease and vascular insufficiency of the upper limbs. The sympathetic blockade helps to relieve pain and ischaemia. Diagnostic STGB is usually performed with local anaesthetics followed by therapeutic blockade with steroids, neurolytic agents or radiofrequency ablation of ganglion. There is increasing popularity and evidence for the use of adjuvants like opioid, clonidine and N Methyl d Aspartate (NMDA) receptor antagonist – ketamine – for the regional and neuroaxial blocks. The action of ketamine with sympatholytic block is through blockade of peripherally located NMDA receptors that are the target in the management of neuropathic pain, with the added benefit of counteracting the “wind-up” phenomena of chronic pain. We studied ketamine as an adjuvant to the local anaesthetic for STGB in 20 cases of peripheral vascular disease of upper limbs during the last 5 years at our institution. STGB was given for 2 days with 2 ml of 2% lignocaine + 8 ml of 0.25% bupivacaine, followed by block with the addition of 0.5 mg/kg of ketamine for three consecutive days. There was significant pain relief of longer duration with significant rise in hand temperature. We also observed complete healing of the gangrenous fingers in 17/19 patients.

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Section: Discussionmentioning

confidence: 99%

Efficacy of stellate ganglion block with an adjuvant ketamine for peripheral vascular disease of the upper limbs

2010

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“…It describes the infiltration at the superior cervical ganglion, the stellate ganglion, and sometimes even the SPG [ 23 – 25 ]. GLOA has been used as a treatment option for neuropathic and sympathetically mediated pain syndromes of the head, face, and upper extremity [ 26 ]. When using the term GLOA, we refer to infiltrations at the superior cervical ganglion as defined by Knolle and Kress [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Retrospective Study on Ganglionic and Nerve Block Series as Therapeutic Option for Chronic Pain Patients with Refractory Neuropathic Pain

Gerken

Fritzsche

Denke

et al. 2020

Pain Research and Management

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Objective. Current recommendations controversially discuss local infiltration techniques as specific treatment for refractory pain syndromes. Evidence of effectiveness remains inconclusive and local infiltration series are discussed as a therapeutic option in patients not responding to standard therapy. The aim of this study was to investigate the effectiveness of infiltration series with techniques such as sphenopalatine ganglion (SPG) block and ganglionic local opioid analgesia (GLOA) for the treatment of neuropathic pain in the head and neck area in a selected patient group. Methods. In a retrospective clinical study, 4960 cases presenting to our university hospital outpatient pain clinic between 2009 and 2016 were screened. Altogether, 83 patients with neuropathic pain syndromes receiving local infiltration series were included. Numeric rating scale (NRS) scores before, during, and after infiltration series, comorbidity, and psychological assessment were evaluated. Results. Maximum NRS before infiltration series was median 9 (IQR 8–10). During infiltration series, maximum NRS was reduced by mean 3.2 points (SD 3.3, p<0.001) equaling a pain reduction of 41.0% (SD 40.4%). With infiltration series, mean pain reduction of at least 30% or 50% NRS was achieved in 54.2% or 44.6% of cases, respectively. In six percent of patients, increased pain intensity was noted. Initial improvement after the first infiltration was strongly associated with overall improvement throughout the series. Conclusion. This study suggests a beneficial effect of local infiltration series as a treatment option for refractory neuropathic pain syndromes in the context of a multimodal approach. This effect is both significant and clinically relevant and therefore highlights the need for further randomized controlled trials.

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“…The desire of patients suffering from chronic orofacial pain syndromes (i.e., typical and atypical trigeminal neuralgia) for immediate pain relief has led to the introduction of first-line treatment options including drug therapy with anticonvulsants or analgetics (i.e., carbamazepine and oxacarbamazepine) and injection of local anesthetics close to sympathetic ganglia [ 13 ]. Beginning in 1980, ganglionic local opioid analgesia (GLOA) started to gain importance in Europe [ 14 ]. Due to the absence of serious adverse side effects reported so far, and to a notable decrease in pain intensity in responders even after a single injection, GLOA was established as a treatment alternative in some cases of orofacial pain syndromes.…”

Section: Discussionmentioning

confidence: 99%

Extensive Craniocervical Abscess after Transoral Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion for Atypical Trigeminal Neuralgia: Report of a Severely Complicated Case

Sproll

Turowski

Depprich

et al. 2018

Case Reports in Medicine

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Ganglionic local opioid analgesia (GLOA) describes the application of low-dose opioids close to sympathetic as, for example, to the superior cervical ganglion. GLOA can be effective in different pain syndromes affecting the head and face region and has been considered to be a safe technique with few complications reported so far. We present the case of a patient who received a single, transoral GLOA for a refractory trigeminal neuralgia. The patient subsequently developed an extensive epidural abscess at the craniocervical junction, requiring ultimately transoral odontoid resection and dorsal stabilisation. This severe complication challenges the role of transoral infiltration therapies in analgetic medicine.

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Ganglionic Local Opioid Application (GLOA) for Treatment of Chronic Headache and Facial Pain

Cited by 12 publications

References 12 publications

Efficacy of stellate ganglion block with an adjuvant ketamine for peripheral vascular disease of the upper limbs

Efficacy of stellate ganglion block with an adjuvant ketamine for peripheral vascular disease of the upper limbs

Retrospective Study on Ganglionic and Nerve Block Series as Therapeutic Option for Chronic Pain Patients with Refractory Neuropathic Pain

Extensive Craniocervical Abscess after Transoral Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion for Atypical Trigeminal Neuralgia: Report of a Severely Complicated Case

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