The Prolongation of Pulse Transit Time After a Stellate Ganglion Block: An Objective Indicator of a Successful Block

Abstract

The relationship between the change of pulse transit time and the presence of clinical signs after stallate ganglion block (SGB) was investigated in patients with disorders mediated by the sympathetic nervous system. SGB is used for the treatment and diagnosis of these disorders; however, a successful objective marker does not exist. Therefore, identifying increased blood flow following SGB and determining whether pulse transit time could be used to verify the success of SBG would be a helpful resource.

Heart rate variability may be more useful than pulse transit time for confirming successful caudal block under general anesthesia in children

“…Pulse transit time (PTT), which is obtained by calculating the time interval between the R-wave peak on the electrocardiogram (ECG) and the maximum upslope of the corresponding photoplethysmographic waveform, is defined as the time interval the arterial pulse pressure wave travels from the aortic valve to the periphery, and it may be a predictor or indicator for confirming successful peripheral nerve or axial block because of the decrease in arterial resistance after sympathetic nerve block [14,15]. Another noninvasive indicator, heart rate variability (HRV), is the physiological variation in the time interval between heartbeats.…”

Detection of the Stellate and Thoracic Sympathetic Chain Ganglia with High-Resolution 3D-CISS MR Imaging

“…The sympathetic chain is generally divided into 2 nerve trunks that extend the entire length of the vertebral column along its lateral aspect. [1][2][3] The stellate ganglion provides sympathetic supply to the head, neck, and up-per limbs, while the sympathetic chain ganglia (SCG) provide key innervations to the thoracic viscera, including the heart. [1][2][3][4][5] The stellate ganglion receives nerve fibers from the C6, C7, and T1 nerve roots with occasional contributions from T2, T3, and T4.…”

“…[1][2][3] The stellate ganglion provides sympathetic supply to the head, neck, and up-per limbs, while the sympathetic chain ganglia (SCG) provide key innervations to the thoracic viscera, including the heart. [1][2][3][4][5] The stellate ganglion receives nerve fibers from the C6, C7, and T1 nerve roots with occasional contributions from T2, T3, and T4. The thoracic sympathetic chain receives nerve fibers from nuclei located within the lateral gray horn of the T2-T8 spinal segment that leave the spinal cord in the anterior rootlets of thoracic nerves, then traverse the white communicating rami, to enter the sympathetic trunk, synapsing onto their target postganglionic neurons in the paravertebral thoracic sympathetic ganglia.…”

“…6,7 Stellate ganglion and SCG blocks are performed for various conditions, including complex regional pain syndrome, postherpetic neuralgia, herpes zoster, causalgia, or intractable angina. 1 An SCG block can also be performed to treat patients with vaso-spasm (eg, primary or secondary Raynaud phenomenon), phantom pain, cardiac arrhythmias (including long QT syndromes), and primary hyperhidrosis. [1][2][3][4][5] Patients are generally referred for SCG block due to persistence of symptoms (pain, vasospasm, hyperhidrosis, and so forth) despite medical management.…”

“…1 An SCG block can also be performed to treat patients with vaso-spasm (eg, primary or secondary Raynaud phenomenon), phantom pain, cardiac arrhythmias (including long QT syndromes), and primary hyperhidrosis. [1][2][3][4][5] Patients are generally referred for SCG block due to persistence of symptoms (pain, vasospasm, hyperhidrosis, and so forth) despite medical management. 4,8-10 An SCG block is routinely performed in the clinical setting with sonography, fluoroscopy, or CT used to provide anatomic landmark guidance.…”