To evaluate the risk of phrenic nerve injury during ultrasound-guided stellate ganglion block (US-SGB) according to sonoanatomy of the phrenic nerve, and determine a safer posture for needle insertion by assessing its relationship with surrounding structure according to positional change.
Twenty-nine healthy volunteers were recruited and underwent ultrasound in two postures, i.e., supine position with the neck extension and head rotation, and lateral decubitus position. The transducer was placed at the anterior tubercle of the C6 level to identify phrenic nerve. The cross-sectional area (CSA), depth from skin, distance between phrenic nerve and anterior tubercle of C6 transverse process, and the angle formed by anterior tubercle, posterior tubercle and phrenic nerve were measured.
The phrenic nerve was clearly identified in the intermuscular fascia layer between the anterior scalene and sternocleidomastoid muscles. The distance between the phrenic nerve and anterior tubercle was 10.33±3.20 mm with the supine position and 9.20±3.31 mm with the lateral decubitus position, respectively. The mean CSA and skin depth of phrenic nerve were not statistically different between the two positions. The angle with the supine position was 48.37°±27.43°, and 58.89°±30.02° with the lateral decubitus position. The difference of angle between the two positions was statistically significant.
Ultrasound is a useful tool for assessing the phrenic nerve and its anatomical relation with other cervical structures. In addition, lateral decubitus position seems to be safer by providing wider angle for needle insertion than the supine position in US-SGB.
Citations
To compare the efficacy of ultrasonography guided stellate ganglion block (US-SGB) with that of blind SGB in management of the stroke patients with complex regional pain syndrome (CRPS) type 1.
Forty-two patients with post-stroke CRPS were randomly assigned to either US-guided SGB (22 patients) or blind SGB group (20 patients). The mean age of US-guided SGB and blind SGB groups was 61.3±5.6 years and 59.1±4.5 years. We performed two blockades at 7-day intervals on the affected side of patients with CRPS. Pain intensity, using a visual analog score (VAS), score of CRPS clinical severity, and the amounts of affected hand swelling with a hand volumeter were assessed before, 2 weeks and 4 weeks after treatment.
In both groups, VAS and the amount of hand swelling were significantly decreased after 2 weeks and after 4 weeks. Between two groups, VAS difference of US-guided SGB group and that of blind SGB group were 2.61±1.09, 1.88±0.62 at 2 weeks and 3.67±1.03, 3.13±0.62 at 4 weeks, respectively. US-guided SGB group showed more significant improvement in mean change of VAS compared to the blind SGB group (p-value<0.05).
Both US-guided SGB and blind SGB techniques were effective in relieving pain in subacute stroke patients with CRPS. US-guided SGB was better in pain relief but has no advantages in reduction of hand swelling in this study.
Citations
Objective: The purpose of this study is to evaluate the efficacy of stellate ganglion block for the patients with cervical Herniated Intervertebral Disc (HIVD).
Method: Forty patients with cervical HIVD were selected for the study. Patients were randomly assigned to one of two groups: Group 1, stellate ganglion block of 1% lidocaine and physical modalities (n=20); Group 2, only physical modalities as a control group (n=20). Group 1 patients were treated with the stellate ganglion block of 1% lidocaine three times over two-week period. The efficacy of stellate ganglion block was assessed with Visual Analog Scale (VAS) on pre- and post-stellate ganglion blocks and with Rubin scale (success rate).
Results: The VAS scores of post-block were significantly lower than pre-score (p＜0.05) in both groups, but there was no statistically significance between the two groups. After treatment, Rubin scale was with excellent or good in 75% in group 1 and in 50% in group 2, but there was no statistically significance.
Conclusion: The stellate ganglion block may be effective therapeutic method for patient with cervical HIVD. But the efficacy of additional stellate ganglion block for cervical HIVD remains controversial. (J Korean Acad Rehab Med 2002; 26: 567-570)
Objective: To evaluate the effects of stellate ganglion block(SGB) in adhesive capsulitis of the shoulder which was not treated with other procedures and therapeutic exercise.
Method: Fifty patients with adhesive capsulitis of the shoulder were assessed by the shoulder range of motion(ROM) and visual analogue scale before and in 30 minutes after the SGB without other procedures and therapeutic exercise.
Results: In 30 minute after the SGB, the shoulder ROM increased 11o in flexion, 14o in abduction, 8o in internal rotation, and 6o in external rotation and visual analogue scale decreased (P＜0.05). The changes of shoulder ROM after the SGB were not significantly related to duration of the adhesive capsulitis of shoulder, except in flexion.
Conclusion: The stellate ganglion block can be another effective method for the patients with adhesive capsulitis of the shoulder.
Objective: The purposes of this study were to measure the effect of Stellate ganglion block(SGB) objectively and quantitatively by the use of sympathetic skin response(SSR), and to evaluate the cumulative effects and complications of repetitive SGB and to find out optimal numbers of injection per one cycle in the patients with reflex sympathetic dystrophy(RSD).
Method: Six patients with RSD were evaluated with a SSR test before and after the injection of 1% lidocaine 4 ml by SGB method.
Results: There was a significant prolongation of latencies in SSR of the lesion side of sixty mixed cases by the SGB methods and SSR tests. There were no significant changes in the latency and amplitude of SSR from the lesion side between pre- and post injection states. There was a significant decrease of amplitude in the sound side after the injection. The differences of the amplitudes between pre- and post injections were significantly higher in the lesion side than the sound side. The degree of pain of the patients with RSD was evaluated by visual analogue scale(VAS), which scored on pre and post injection state decreased from 10 to 6.5 by 5 times injections, but did not decrease by more injections.
Conclusion: We concluded that SGB is more effective in the RSD lesion side than the sound side and the SSR is a useful test for evaluating the effect of SGB.
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