Multiple bilateral ultrasound-guided stellate ganglion blocks to treat acute vasculitis in a recently diagnosed patient of systemic lupus erythematosus

Punj, Jyotsna

doi:10.4103/ija.ija_331_19

Cited by 12 publications

(13 citation statements)

References 13 publications

(25 reference statements)

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“…Many countries most commonly use 0.25–0.375% bupivacaine, and 0.4–1% lidocaine is widely used in China. The injection volume of the anesthetic is generally 4–5 ml ( 14 , 15 ). Yoo et al ( 16 ) compared the SGB effects of 4-, 6-, and 8-ml dosses of local anesthetics and found that there was no significant difference.…”

Section: Discussionmentioning

confidence: 99%

Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound

Shan

Chen

et al. 2022

Front. Surg.

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ObjectiveThis study aimed to investigate the effects of stellate ganglion block (SGB) through different approaches under guidance of ultrasound.MethodsA total of 130 patients undergoing SGB in our hospital between February 2019 and February 2020 were enrolled as the research subjects. According to the random number table method, these subjects were divided into two groups: a modified 6th cervical vertebra (C6) group (n = 65) and a 7th cervical vertebra (C7) group (n = 65). Under the guidance of ultrasound, the subjects in the modified C6 group were punctured at the level of the C6 transverse process, and the subjects in the C7 group were punctured at the level of the C7 transverse process. The operation duration, number of puncture angle adjustments, block effects, and adverse reactions for SGB were compared between the two groups.ResultsThe modified C6 group showed shorter SGB operation duration and a lower number of puncture angle adjustments than the C7 group, and the differences were statistically significant (P < 0.05). Horner Syndrome occurred in both groups after SGB. The incidence of adverse reactions in the modified C6 group was 4.62%, comprising 1 case of hoarseness and 2 cases of slowed pulse, while that in the C7 group was 6.15%, with 1 case of hoarseness and 3 cases of slowed pulse; the difference between the two groups was not statistically significant (P > 0.05).ConclusionThe operation duration for modified SGB guided by ultrasound puncturing at the C6 transverse process is shorter and requires fewer puncture angle adjustments than puncturing at the C7 transverse process; however, there is no significant difference between the incidence of adverse reactions or the blocking effects of the two methods.

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Section: Discussionmentioning

confidence: 99%

Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound

Shan

Chen

et al. 2022

Front. Surg.

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“…• Reduction of natural killer cell activity (Sugimoto et al, 1999;Yokoyama et al, 2000) • Reduction of inflammatory cytokines IL-1, IL-4, IL-6, IL-8, TNF-α (Liu et al, 2013;Yang et al, 2015;Chen et al, 2018) • Increase of antiinflammatory cytokine IL-10 and of CGRP (Liu et al, 2013;Yang et al, 2015;Chen et al, 2018) Regulation of the endothelial dysfunction (Chen et al, 2012) Regulation of microcirculation and coagulopathy (Levy and Lorch, 1996;Hanamatsu et al, 2002;Pfister and Fischer, 2009;Yamazaki et al, 2012;Zhou et al, 2014;Punj, 2019) Reduction of (neurogenic) pulmonary edema (Pierach and Stotz, 1952;Zhang et al, 2013;Liu et al, 2017;Chen et al, 2018) Reduction of pulmonary arterial hypertension (Myers et al, 1998) Reduction of pathological positive feedback loops (Fischer, 2003;Jänig, 2011;Fischer, 2019) and has been favorably influenced by SGB in animal experiments (Chen et al, 2012). Leptin, released from adipocytes, also plays a role in arterial hypertension in collaboration with the SNS, and it causes endothelial dysfunction and increased blood pressure (Wang et al, 2013).…”

Section: Tablementioning

confidence: 99%

“…Crucial is sympathetic hyperactivity which influences coagulation and fibrinolysis pathways and causes microthrombi with increased plasma D-dimers (Ur and Verma, 2020b). SGB also has an effect on pulmonary arterial hypertension and thus on microcirculation (Myers et al, 1998;Zhao et al, 2019) and is therefore a logical intervention for microcirculation disorders and coagulopathy (Murakawa, 1993;Levy and Lorch, 1996;Hanamatsu et al, 2002;Pfister and Fischer, 2009;Yamazaki et al, 2012;Zhou et al, 2014;Punj, 2019) (Fig. 4).…”

Section: Regulation Of Microcirculationdisturbance and Coagulopathy By Sgbmentioning

confidence: 99%

Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19

Fischer¹,

Barop²,

Ludin³

et al. 2022

Autonomic Neuroscience

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Whereas the autonomic nervous system (ANS) and the immune system used to be assigned separate functions, it has now become clear that the ANS and the immune system (and thereby inflammatory cascades) work closely together. During an acute immune response (e. g., in viral infection like Covid-19) the ANS and the immune system establish a fast interaction resulting in "physiological" inflammation. Based on our knowledge of the modulation of inflammation by the ANS we propose that a reflectory malfunction of the ANS with hyperactivity of the sympathetic nervous system (SNS) may be involved in the generation of acute hyperinflammation. We believe that sympathetic hyperactivity triggers a hyperresponsiveness of the immune system ("cytokine storm") with consecutive tissue damage. These reflectory neuroimmunological and inflammatory cascades constitute a general reaction principle of the organism under the leadership of the ANS and does not only occur in viral infections, although Covid-19 is a typical current example therefore. Within the overreaction several interdependent pathological positive feedback loops can be detected in which the SNS plays an important part. Consequently, there is a chance to regulate the hyperinflammation by influencing the SNS. This can be achieved by a stellate ganglion block (SGB) with local anesthetics, temporarily disrupting the pathological positive feedback loops. Thereafter, the complex neuroimmune system has the chance to reorganize itself. Previous clinical and experimental data have confirmed a favorable outcome in hyperinflammation (including pneumonia) after SGB (measurable e. g. by a reduction in proinflammatory cytokines).

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“…Stellate ganglion block (SGB) has been used for the management of sympathetically mediated pain and ischemic disorders of the upper extremity, chest, head and face that include complex regional pain syndrome, postherpetic neuralgia, migraine, tinnitus, and refractory angina [ 5 ]. A few case reports have described successful SGB therapy of ischemia and pain caused by vascular complications of rheumatic conditions such as Raynaud disease [ 6 , 7 ], temporal arteritis [ 8 ], and vasculitis induced by systemic lupus erythematosus [ 9 ]. Furthermore, SGB has also been used with some success in treating bronchial asthma [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Stellate ganglion block as an intervention in refractory eosinophilic granulomatosis with polyangiitis: a case report

Xue

Shi

et al. 2022

Allergy Asthma Clin Immunol

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Background Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare vasculitis. Although glucocorticoid therapy with or without immunosuppressants leads to remission in the majority of cases, most EGPA patients remain dependent on glucocorticoid therapy and experience frequent relapses. Here, we report a case of refractory EGPA which responded to stellate ganglion blocks (SGBs). Case presentation A 32-year-old woman with aggravated wheezing, purpura, numbness of multiple fingers, and epigastric and abdominal pain was referred to our clinic. Laboratory and radiographic studies led to the diagnosis of EGPA. After an initial favorable response to glucocorticoid and immunosuppressant therapy, she experienced a relapse during a glucocorticoid taper. We found that SGB brought symptomatic relief and impeded disease progression. The mechanism of action of SGB on EGPA is undetermined, but may be related to vasodilation, immune modulation, and central nervous system regulation. Conclusions This report not only proposes a novel treatment modality for EGPA, but also provides a clinical reference point for further in-depth studies of SGB in multiple immune-linked disorders.

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Multiple bilateral ultrasound-guided stellate ganglion blocks to treat acute vasculitis in a recently diagnosed patient of systemic lupus erythematosus

Cited by 12 publications

References 13 publications

Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound

Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound

Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19

Stellate ganglion block as an intervention in refractory eosinophilic granulomatosis with polyangiitis: a case report

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