Preoperative Stellate Ganglion Block for Perioperative Pain in Lateralized Head and Neck Cancer: Preliminary Results

Abstract

Patients with head and neck cancer represent a vulnerable population at particular risk of opioid dependence due to frequent histories of substance abuse, requirement of extensive surgery, and the synergistic toxicity of multimodal therapy. Regional anesthetic techniques have been used by other surgical disciplines to facilitate early recovery after surgery and decrease postoperative patient narcotic requirements. This pilot study investigates the efficacy of a preoperative regional analgesia using stellate ganglion block in lateralized head and neck cancer surgery. From our early results, stellate ganglion blockade may hold promise as an effective preoperative intervention for controlling early postoperative pain, lessening narcotic requirements, and improving quality of life.

Treatment of stellate ganglion block in diseases: Its role and application prospect

“…The therapeutic mechanism of SGB may be involved in improving the blood supply to the head and neck, inhibiting the hyperexcitability of sympathetic nerves, and reducing the synthesis and release of vasoconstricting substances, such as nitric oxide and prostaglandin. Similar cases on the treatment of SGB have also been reported for postoperative pain in head and neck cancer[ 18 ], peripheral arterial pain (Raynaud’s disease[ 19 ], Burger’s disease, diabetic vascular disease, arterial embolism, etc. ), and neoplastic pain (pain after breast cancer resection)[ 20 , 21 ].…”

Enhanced recovery and medical management after head and neck microvascular reconstruction

“…Gabapentin, in particular, appears to provide a significant ameliorative effect on postoperative pain and analgesic consumption when administered preoperatively and continued in the postoperative setting [93,94] . Regional anesthesia through nerve blocks performed pre-and intra-operatively has demonstrated success in reducing postoperative pain scores without a significant increase in morbidity [95,96] . Notably, however, intraoperative infusion of long-acting local anesthetics into donor sites after harvest for free flap reconstruction does not appear to reduce postoperative pain scores [97] .…”

“…Notably, however, intraoperative infusion of long-acting local anesthetics into donor sites after harvest for free flap reconstruction does not appear to reduce postoperative pain scores [97] . Additionally, the use of longer-acting opioids or those with reduced habit-forming potentials, such as methadone or tramadol, decreases overall opioid usage, reduces postoperative pain, and increases patients' quality of life [95,98,99] .…”