Minimal Volume of Local Anesthetic Required for an Ultrasound-Guided SGB

Lee, Mi Hyeon; Kim, Ki Yeob; Song, Jang Ho; Jung, Hyun Jun; Lim, Hyun Kyoung; Lee, Doo Ik; Deog, Young

doi:10.1111/j.1526-4637.2012.01495.x

Cited by 34 publications

(36 citation statements)

References 14 publications

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“…12 Ultrasound guidance could improve the accuracy of local anesthetic injection into target site. 15,16 The use of ultrasound-guided in the index case it apparently helpful in achieving therapeutic action.…”

Section: Discussionmentioning

confidence: 99%

“…Briefly, 2-mL 2% lidocaine was injected between the internal carotid artery and the longus colli at the C7 level under ultrasound guidance ( Figure 2). 15,16 The block was repeated once every day, and the pain subsided rapidly in both intensity and frequency along with the advancement of daily treatment. On the seventh day after treatment initiation, the patient no longer had pain episode.…”

Section: Case Presentationmentioning

confidence: 99%

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<p>Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review</p>

Liu¹,

Qing²,

Tang³

et al. 2020

JPR

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Background: Central post-stroke pain (CPSP) is refractory to pharmacotherapy (eg, NSAIDs, opioids, antidepressants, and anticonvulsants), and may require transcranial or deep brain stimulation. Case Presentation: A 67-year-old woman presented with severe paroxysmal cramp-like pain on the right side, including the head and both upper and lower extremities. The pain started 5 years earlier, was initially mild and occasional, but gradually intensified to an unbearable degree with an average of 10-15 daily episodes, each lasting for 5-10 mins. The patient disclosed "hemorrhagic stroke" 10 years ago that resulted in hemiplegia on the right side. CT examination verified the lesion. The patient received daily injection of 2-mL 2% lidocaine under ultrasound guidance to block the stellate ganglion. Pain subsided rapidly in both intensity and frequency. On the seventh day, the patient no longer had pain episodes. At the last follow-up, 9 months later, the patient was free from pain. Conclusion: Ultrasound-guided stellate ganglion block is a viable alternative for CPSP that is refractory to pharmacotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

<p>Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review</p>

Liu¹,

Qing²,

Tang³

et al. 2020

JPR

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“…They demonstrated how ultrasound-guided C6-SGB is performed beneath the prevertebral fascia in the longus colli muscle. Another study reported that a 2 mL dose is sufficient for a successful block when performing an ultrasound-guided SGB 12. Following the report of Narouze et al,13 we typically use 5 mL of the local anesthetic for ultrasound-guided SGB.…”

Section: Discussionmentioning

confidence: 96%

Retention of finger blood flow against postural change as an indicator of successful sympathetic block in the upper limb

Nakatani

Hashimoto

Sutou

et al. 2017

JPR

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BackgroundSympathetic block in the upper limb has diagnostic, therapeutic and prognostic utility for disorders in the upper extremity that are associated with sympathetic disturbances. Increased skin temperature and decreased sweating are used to identify the adequacy of sympathetic block in the upper limb after stellate ganglion block (SGB). Baroreflexes elicited by postural change induce a reduction in peripheral blood flow by causing sympathetic vasoconstriction. We hypothesized that sympathetic block in the upper limb reduces the decrease in finger blood flow caused by baroreflexes stimulated by postural change from the supine to long sitting position. This study evaluated if sympathetic block of the upper limb affects the change in finger blood flow resulting from postural change. If change in finger blood flow would be kept against postural changes, it has a potential to be a new indicator of sympathetic blockade in the upper limb.MethodsSubjects were adult patients who had a check-up at the Department of Pain Management in our university hospital over 2 years and 9 months from May 2012. We executed a total of 91 SGBs in nine patients (N=9), which included those requiring treatment for pain associated with herpes zoster in seven of the patients, tinnitus in one patient and upper limb pain in one patient. We checked for the following four signs after performing SGB: Horner’s sign, brachial nerve blockade, finger blood flow measured by a laser blood flow meter and skin temperature of the thumb measured by thermography, before and after SGB in the supine position and immediately after adopting the long sitting position.ResultsWe executed a total of 91 SGBs in nine patients. Two SGBs were excluded from the analysis due to the absence of Horner’s sign. We divided 89 procedures into two groups according to elevation in skin temperature of the thumb: by over 1°C (sympathetic block group, n=62) and by <1°C (nonsympathetic block group, n=27). Finger blood flow decreased significantly just after a change in posture from the supine to long sitting position after SGB in both groups. In the sympathetic block group, the ratio of finger blood flow in the long sitting position/supine position with a change in posture significantly increased after SGB compared with before SGB (before SGB: range 0.09–0.94, median 0.53; after SGB: range 0.33–1.2, median 0.89, p<0.0001).ConclusionOur study shows that with sympathetic block in the upper limb, the ratio of finger blood flow significantly increases despite baroreflexes stimulated by postural change from the supine to long sitting position. Retention of finger blood flow against postural changes may be an indicator of sympathetic block in the upper limb after SGB or brachial plexus block.

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“…Kapral et al [ 7 ] and Narouze et al [ 13 ] reported a successful treatment effect with 5 mL of local anaesthetic in ultrasound-guided SGB. Two studies reported on the optimal volume of local anaesthetic required for successful ultrasound-guided SGB compared to the traditional approach [ 14 , 15 ]. One study showed that 4 ml of 0.2% ropivacaine was sufficient for a successful block [ 14 ], while the other showed the optimal volume was 2 ml of 0.5% mepivacaine [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of ultrasound-guided stellate ganglion block on cervical vascular blood flow: study protocol for a randomized controlled trial

Chen

et al. 2018

Trials

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BackgroundThe stellate ganglion block (SGB) can lead to vasodilation of the head and neck. However, controversy remains concerning the changes in extracerebral blood flow. The objective of this study is to assess the effects of SGB on the blood flow to the neck.MethodsA randomized controlled crossover trial with 38 participants will be conducted. Participants who have primary headaches will be assigned to either group A or B. Patients in group A will receive SGB with 6 ml 1% lidocaine, and after a one-week washout period, they will undergo the second SGB with 6 ml normal saline. In contrast, patients in group B will receive the opposite protocol. Data will be collected at baseline (T0) and at 15 min after the first intervention (T1), 15 min before the second intervention (T2), 15 min after the second intervention (T3) and at a 3-week follow up (T4). T1 is the primary time point for the primary outcome analysis. The primary outcomes include the peak systolic velocity (PSV), the end diastolic velocity (EDV), resistance index (RI) and vessel diameter of the common carotid artery (CCA) and vertebral artery (VA). The secondary outcomes include the rate of ptosis, the rate of conjunctival flushing, and the numerical rating scale (NRS) pain score. Additionally, adverse events (AEs) or serious adverse events (SAEs) will be collected at each assessment point.DiscussionThis study will comprehensively investigate the efficacy of SGB in extracerebral blood flow. Our research may also suggest that SGB will be effective in reducing pain in patients with primary headaches.Trial registrationChinese Clinical Trial Registry, identifier ChiCTR-IOR-17011536. Registered on 1 June 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2736-y) contains supplementary material, which is available to authorized users.

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Minimal Volume of Local Anesthetic Required for an Ultrasound-Guided SGB

Abstract: In conclusion, when performing an ultrasound-guided SGB, 2 mL dosage was sufficient for a successful block as the previous, conventional volume. Therefore, when performing an ultrasound-guided SGB, we recommend the 2 mL dosage of local anesthetics for a successful block.

Cited by 34 publications

References 14 publications

<p>Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review</p>

<p>Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review</p>

Retention of finger blood flow against postural change as an indicator of successful sympathetic block in the upper limb

Effects of ultrasound-guided stellate ganglion block on cervical vascular blood flow: study protocol for a randomized controlled trial

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