Ultrasound Guided Stellate Ganglion Block with Dexmedetomidine as an Adjuvant in Complex Regional Pain Syndrome (CRPS)

Shrestha, Babu Raja; Lama, S; Shrestha, Ujma

doi:10.3126/kumj.v19i1.49606

Cited by 6 publications

(4 citation statements)

References 4 publications

(4 reference statements)

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“…Possible mechanisms through which SGB contributes to hemodynamic stability include: (1) Suppressing sympathetic excitation, thereby reducing the stress response; (2) Decreasing the release of noradrenaline and neuropeptide Y, along with a reduction in sympathetic ganglia activity, which in turn diminishes adrenaline secretion [19]; (3) Modulating the function of the hypothalamic-pituitary-adrenal axis, leading to decreased levels of cortisol, aldosterone, angiotensin, serotonin, and substance P, and an increase in insulin secretion. This helps regulate the endocrine system and mitigate the intraoperative stress response [20]. The findings of this study further indicate that SGB helps prevent fluctuations in HR and MAP, thereby contributing to the maintenance of hemodynamic stability.…”

Section: Discussionsupporting

confidence: 55%

Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy

Yang

2024

Am J Transl Res

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Objective: To investigate the effect of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and serum S100B during carotid endarterectomy (CEA). Methods: Patients who were prospectively enrolled to receive CEA under elective general anesthesia were randomized into an SGB group and a control group (ChiCTR2000033385). Before anesthesia, the SGB group underwent ipsilateral SGB under ultrasound guidance, while the control group did not. Ultrasound-guided right subclavian internal jugular vein catheterization was performed under general anesthesia. Mean arterial pressure (MAP) and heart rate (HR) were monitored at various time points (T0-T4). Arterial and internal jugular venous bulb blood were collected for blood gas analysis, determining jugular venous oxygen saturation (SjvO 2 ), arteriovenous oxygen difference (AVDO 2 ), cerebral oxygen extraction ratio (COER), lactate production rate (LPR), and lactate-oxygen index (LOI). The serum concentration of S100B in the internal jugular venous bulb at each time point was measured. Results: The results revealed significantly lower HR during anesthesia induction and surgery in the SGB group, with more stable MAP and HR during endotracheal intubation and surgery compared to the control group (P<0.05). The control group exhibited decreases at T3 and a slight increase at T4. SjvO 2 was significantly higher in the SGB group, while AVDO 2 and COER gradually decreased over time, but they were significantly higher in the control group (P<0.05). LPR and LOI in both groups peaked at T3 and were significantly different between T4 and T2 (P<0.05). Serum S100B levels in both groups rose and then decreased at each time point, but they were consistently lower in the SGB group (P<0.05). Conclusion: SGB before CEA effectively suppresses the stress response, maintains intraoperative hemodynamic stability, improves brain tissue oxygen supply, and demonstrates a neuroprotective effect.

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Section: Discussionsupporting

confidence: 55%

Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy

Yang

2024

Am J Transl Res

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“…In upper limb surgery, 3 mL 2% lidocaine + 0.5 μg/kg dexmedetomidine for SGB can reduce the use of tramadol within 24 h after surgery, prolong postoperative analgesia time, and has more advantages than intravenous dexmedetomidine. Shrestha et al 125 recently proposed ultrasound-guided SGB with dexmedetomidine as an adjuvant for treating Complex Regional Pain Syndrome (CRPS). This case report exposed that dexmedetomidine as an adjuvant of LA in SGB did not cause significant side effects.…”

Section: Application Of Dexmedetomidine In Peripheral Nerve Blockmentioning

confidence: 99%

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

Chen¹,

Liu²,

Feng³

et al. 2023

DDDT

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Peripheral nerve block technology is important to balanced anesthesia technology. It can effectively reduce opioid usage. It is the key to enhance clinical rehabilitation as an important part of the multimodal analgesia scheme. The emergence of ultrasound technology has accelerated peripheral nerve block technology development. It can directly observe the nerve shape, surrounding tissue, and diffusion path of drugs. It can also reduce the dosage of local anesthetics by improving positioning accuracy while enhancing the block’s efficacy. Dexmedetomidine is a highly selective drug α 2 -adrenergic receptor agonist. Dexmedetomidine has the characteristics of sedation, analgesia, anti-anxiety, inhibition of sympathetic activity, mild respiratory inhibition, and stable hemodynamics. Numerous studies have revealed that dexmedetomidine in peripheral nerve blocks can shorten the onset time of anesthesia and prolong the time of sensory and motor nerve blocks. Although dexmedetomidine was approved by the European Drug Administration for sedation and analgesia in 2017, it has not yet been approved by the US Food and Drug Administration (FDA). It is used as a non-label drug as an adjuvant. Therefore, the risk-benefit ratio must be evaluated when using these drugs as adjuvants. This review explains the pharmacology and mechanism of dexmedetomidine, the effect of dexmedetomidine on various peripheral nerve block as an adjuvant, and compare it with other types of adjuvants. We summarized and reviewed the application progress of dexmedetomidine as an adjuvant in nerve block and look forward to its future research direction.

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“…Thapa et al utilized dexmedetomidine as an adjuvant to lidocaine in the stellate ganglion block and found a significant decrease in tramadol use within 24 hours of surgery [ 9 ]. Recent research by Shrestha et al suggests that ultrasound-guided SGB combined with dexmedetomidine can effectively treat CRPS [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as an Adjunct in a Fluoroscopically Guided Stellate Ganglion Block for Complex Regional Pain Syndrome

Sheikh¹,

Baig²

2023

Cureus

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Complex regional pain syndrome (CRPS) is a chronic pain disorder characterized by pain that is disproportionate to the inciting event. Autonomic and inflammatory responses predominate, and treatment plans that explicitly target these responses reduce symptoms for longer periods of time, are typically better tolerated, and have more favorable outcomes. Our patient was a young male who presented with a four-month history of a road traffic accident (RTA) that resulted in a fractured left distal radius and scaphoid. His main complaint was pain and discomfort, even after surgical forearm stabilization, as well as hyperesthesia, restricted range of motion, and new-onset tremors. The patient was provisionally diagnosed with complex regional pain syndrome (CRPS) and booked for a fluoroscopically guided stellate ganglion block when the oral medication regime provided minimal relief. A stellate ganglion block was administered using a combination of ropivacaine, methylprednisolone, and dexmedetomidine under fluoroscopic guidance. During our routine outpatient follow-ups, our patient's pain score on the visual analog scale (VAS) fell to zero, the burning, vasomotor, and temperature abnormalities subsided, and he gradually regained the use of his left forearm and hand. The etiology of complex regional pain syndrome is multifaceted. Early identification and therapy typically halt the progression. Long-term outcomes are improved by treatment strategies that target inflammatory and autonomic responses. Dexmedetomidine has a mild anti-nociceptive action when used as an adjuvant in peripheral nerve blocks and ganglion blocks, blocking pain transmission in Aδ and C fibers. We feel that by combining dexmedetomidine and a stellate ganglion block, we could provide immediate and long-term relief to our patient. More research is needed to monitor and analyze the efficacy of dexmedetomidine as a treatment for chronic pain syndromes such as CRPS.

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Ultrasound Guided Stellate Ganglion Block with Dexmedetomidine as an Adjuvant in Complex Regional Pain Syndrome (CRPS)

Cited by 6 publications

References 4 publications

Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy

Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

Dexmedetomidine as an Adjunct in a Fluoroscopically Guided Stellate Ganglion Block for Complex Regional Pain Syndrome

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