• The Korean Journal of Pain
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• v.8 no.1
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• pp.60-64
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• 1995

Stellate ganglion block is a selective sympathetic blockade affecting the head and neck, and the upper extemity. It is an important method which has been used most frequently in neuro-pain clinic due to its wide range of indications. The authors attermpted to define the minimal volume of local anesthetic which need for successful stellate ganglion block by using 1% mepivacaine HCl mixed with dye. In 40 heathy volunteers, two different volumes, 3 ml in the group 1 (n=20) and 4 ml in the group 2 (n=20), were injected by an anterior paratracheal technique at the sixth cervical vertebral level. We compared the degree in sympathetic blockade by clinical sings and symptoms and also checked the spread range of dye by plain X-ray. With seven criteria for an effective block. mean score was 5.7 in group 2, while 3.4 in group 1. These results suggest that 4 ml of local anesthetic are adequate for a successful stellate ganglion block.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.128-131
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• 1999

Stellate ganglion block is a well established method for the management of certain pain syndromes (e.g., chronic regional pain syndrome, facial pain) in the cervicothoracic region and upper extremity. The stellate ganglion resides between the C7 transverse process and the head of the first rib. Anesthetic injections for the stellate ganglion block are typically made at the level of the transverse process of either the C6 or C7 vertebrae to avoid the pleura, vessels, and nerve roots. Method of positioning the needle tip directly at the ganglion has been described, but are problematic because of the risk of injury to or injection into adjacent structures. It is necessary to know the exact anatomic position of the stellate ganglion when permanent blockade is required by means of radiofrequency thermocoagulation. Whereas fluroscopy shows only bony feature, computerized tomography also images nerves, vessels, and lung, allowing accruate needle placement. We report a case of the percutaneous radiofrequency thermocoagulation of the stellate ganglion after computerized tomography-guided localization.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.346-349
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• 1998

The technique of the stellate ganglion block is widely used as it is relatively simple and safe. But it can cause severe complications because there are major blood vessels and nerves around the stellate ganglion. We practiced CPR because of the respiratory failure caused by severe hematoma in the neck following the stellate ganglion block. A 46-year-old male patient admitted to ENT department because of the both sudden sensorineural hearing loss that happened after URI. He was referred to Pain Clinic for further evaluation and treatment. We decided to block the stellate ganglion. We injected 6ml of 0.5% mepivacaine on both sides of the stellate ganglion. There were no blood aspiration and abnormal vital signs during the 30 minute observation, either. Three hours after he went to the private room, he had pain and edema in his neck, but no respiratory defficulty. But later, respiratory failure was suddenly followed. So we practiced CPR. We confirmed severe hematomas in the neck through CT scanning. Hematomas is removed and the ruptured blood vessels which is supposed to be muscular branch of vertebral artery is ligated under general anesthesia. The patient was discharged from hospital after the treatment of pneumonia and duodenal ulcer as complications. We recommand you to compress the block site more than five minutes and not to prick with the needle several times at one point to prevent the formation of hematomas.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.162-169
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• 1994

Blockade of cervicothoracic sympathetic ganglion (stellate ganglion controls pain on face, head, neck, shoulder, upper limbs, and upper chest, including their viscera and sympathetically maintained pain. This procedure also increases blood flow to the above areas and relieves hyperreactivity of sympathetic nervous system. Clinically, repeated stellate ganglion blocks with local anesthetic agent may become difficult with complications such as accidental intravascular or subdural injection, recurrent laryngeal nerve or bracheal plexus paralysis, pneumothorax and edema on injection site. Therefore, at times long-term cervicothoracic ganglion block with neurolytics is necessitated but its applications are prohibited by the critical structures surrounding ganglion. There are also few reports of neurolytic stellate ganglion block. This study was performed to observe the complications, gross changes of surrounding structures, and microscopic findings of ganglion cells after neurolytic block and to certify the possibility of clinical use of neruolytic stellate ganglion block. The unilateral superior cervical sympathetic ganglion of rabbit was blocked with absolute ethyl alcohol 0.4 ml at the level of cricoid cartilage. Normal ganglion was used as a control and 5 animals were sacrificed at each intervals of 7, 15 and 50 days after block. The results were as follows; 1) All experimental animals showed no specific changes of behavior, motor function. No necrotic tissues were present in the block area during the observation period. There were some gross scar tissues along the fascia of muscles surrounding the needle injection site, but gross atrophy of muscles or injured major vessels were not found. 2) Microscopically, structures of normal ganglion of rabbit were very similar to those of humans. Seven days after absolute ethyl achohol injection there were marked edema of ganglion cells and nuclei with irregular nuclear membrane. Some of the ganglion cells lost their nuclei and showed degenerative changes. Fifteen days after block, cell edema were decreased and loss of the Nissl's body was prominant. The ganglion cell structures looked close to normal but the cytoplasm and nucleus were generally contracted 50 days after block. These results suggest absolute ethyl alcohol injection on cervical sympathetic ganglion with above method mainly blocks pre- and post-synaptic fibers and the long-term neurolytic blockade of this ganglion may be possible in rabbits.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.231-233
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• 2001

Atrophic rhinitis is characterized by mucosal atrophy, bony absorption, persistent fetid odor and resistance to medical and surgical treatment. Stellate ganglion block (SGB) can be used as a therapeutic modality by improving the regional blood flow through sympathetic blockade. We present a case of a 57 year-old male patient who had been treated unsuccessully for atrophic rhinitis for several years by surgical and conservative measures. The patient presented at our pain clinic with shoulder pain and received stellate ganglion block once or twice a week. He received more than 75 SGBs in addition to the routine conservative treatment for atrophic rhinitis. As the number of blocks performed increased, the patient demonstrated subjective symptom relief. We measured regional mucosal blood flow using a laser doppler flowmeter after the 28th, 63rd and 75th blocks. Nasal mucosal blood flow was improved by 4.9%, 28.8% and 36.3% respectively. We also were able to observe the recovery of mucosal atrophy to an almost normal level by nasal endoscopy. The patient is currently free of symptoms and is being followed up on an outpatient bases.

• The Korean Journal of Pain
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• v.20 no.2
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• pp.246-250
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• 2007

We report here on a case of right side spasmodic torticollis (ST) that was refractory to botulinum toxin type A injection and medication. The patient finally underwent a selective ramisectomy with ipsilateral sternocleidomastoid muscle (SCM) resection, but the remaining symptoms slowly aggravated, and a contralateral left side SCM spasm began. As conservative therapy for reducing the spasmodic symptoms, accessory nerve block, upper cervical plexus block and stellate ganglion block were performed twice in a week. After 6 months, the spasmodic symptoms significantly decreased. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) decreased by more than 70%. After one year of serial intermittent local anesthetic blockade therapy, the patient became almost free from the original ST symptoms (TWSTRS = 1). Serial local anesthetic interventions for the ST patient may have a beneficial role on the pathological peripherocentral neural activity of the ST patient and can modulate motor-sensory integration in the patient.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.263-269
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• 1994

Causaliga is a syndrome of sustained burning pain, allodynia and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes. Various treatments of causalgia contain sympathetic blockade, sympathectomy, transcutaneous electrical nerve stimulation, physical therapy, cryotherapy and psychotherapy. Repeated stellate ganglion blocks with 6ml of 0.25% bupivacaine provided good results for 2 patients. We recommand sympathetic blocks for treatment of causalgia.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.340-343
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• 1996

Background: In our hospital, stellate ganglion block(SGB) has been performed for the prevention and treatment of vasospasm after microscopic reimplantation of finger(s). If brachial plexus block(BPB) has the same effect of sympathetic block on the upper extremity as SGB, it may be preferable to the SGB because it povides postoperative analgesia and is administered continuously. So we measured and compared the change of skin temperature on the forearm as the parameter of sympathetic blockade after SGB and BPB. Methods: The forty-two patients, belonged to ASA class 1~2, were received BPB for hand surgery. The skin temperature was measured before and after BPB on the forearm with patient monitor(LN 6199, YSI 400 Series Temperature Probe, Hellige, Germany). After 24 hours, ipsilateral SGB was performed and skin temperature was recorded before and after SGB. Results: The increase of skin temperature after procedures was $1.1{\pm}0.5^{\circ}C$(from $34.5{\pm}0.7^{\circ}C$ to $35.6{\pm}0.5^{\circ}C$) in BPB and $0.6{\pm}0.3^{\circ}C$(from $34.9{\pm}0.5^{\circ}C$ to $35.5{\pm}0.5^{\circ}C$) in SGB. The changes of skin temperature in both blocks were statistically significant(p<0.01), and the skin temperatures after each procedure were revealed no significant difference(p$\simeq$0.62). Conclusion: We thought that BPB produced sympathetic blockade on the upper extremity as much as SGB. Moreover, it provides postoperative pain relief and may be employed as continuous BPB could be used for hand surgery with many advantages.

• The Korean Journal of Pain
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• v.13 no.2
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• pp.182-186
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• 2000

Background: Ropivacaine is a new amide local anesthetics, having therapeutic properties similar to those of bupivacaine but less cardiovascular toxicity and motor blockade. The aim of this study was to evaluate the effects of ropivacaine used in stellate ganglion block (SGB) compared with those of lidocaine or bupivacaine. Methods: This prospective and crossover study performed in twenty patients with sudden sensory neural hearing loss. All patients received three times SGB, in the paratracheal approach using 8 ml of 1% lidocaine, 0.2% bupivacaine, and 0.2% ropivacaine respectively without any orders. Onset time and action duration of Horner's syndrome were observed after each SGB. Results: Onset time of ropivacaine was the middle of the three agents; earlier lidocaine and slower bupivacaine. Lidocaine ($3.0{\pm}1.9$ min), bupivacaine ($4.1{\pm}2.9$ min) and ropivacaine ($3.3{\pm}1.3$ min). But there were no significant differences; Action duration of Horner's syndrome of ropivacaine (223.6?105.2 min) was longer than lidocaine ($134.6{\pm}77.3$ min) and shorter than bupivacaine ($241.2{\pm}115.8$ min). There were significant differences in the action duration of each local anesthetics (P<0.05). There was no critical side effects and temporary foreign body sensation was the most common side effect. Conclusions: We conclude that ropivacaine is a good alternative in SGB instead of lidocaine or bupivacaine. Ropivacaine is a long acting local anesthetic similar to those of bupivacaine with wide margin of safety. However, optimal concentration and volume of ropivacaine in SGB should be studied.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.68-71
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• 2006

Background: Stellate ganglion block (SGB) is a selective sympathetic blockade that affects the head, neck and the upper extremities. It is an important method that has been frequently used in pain clinics due to its wide range of indications. But there were some problem with performing SGB at C6 or C7. Thus, various techniques have been recently introduced to successfully perform SGB; among them, there is the oblique approach. This study was performed to evaluate the effectiveness of the oblique approach for performing SGB in C7. Methods: Forty six patients with sudden hearing loss were studied. In group I, the patient underwent C7 oblique SGB with 1% mepivacaine (3 ml) under fluoroscopic guidance. In group II, the patients underwent the C7 classical anterior approach SGB with 1% mepivaine (5 ml) under fluoroscopic guidance. We compared the occurrence of Horner's syndrome, the side effects and the changes of temperature of the skin of the hand. Results: The rate of Horner's syndrome was 81.5% in the group I and 84.2% in the group II. The rate of incurring increased skin temperature (${\geq}34^{\circ}C$) of the fingers was 77.7% and 79.4% in each group, respectively. Conclusions: The C7 oblique approach for SGB showed the same SGB effect compared with the C7 anterior approach for SGB, and there were also fewer complications. We conclude that C7 oblique SGB may be a beneficial method for treating patients with this particular malady.