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"Stellate ganglion block"

Original Articles

Efficacy of Ultrasonography Guided Stellate Ganglion Blockade in the Stroke Patients with Complex Regional Pain Syndrome
Seung Don Yoo, Sang Soo Jung, Hee-Sang Kim, Dong Hwan Yun, Dong Hwan Kim, Jinmann Chon, Dong Whan Hong
Ann Rehabil Med 2012;36(5):633-639.   Published online October 31, 2012
DOI: https://doi.org/10.5535/arm.2012.36.5.633
Objective

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.

Method

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.

Results

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).

Conclusion

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

Citations to this article as recorded by  
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    Current Physical Medicine and Rehabilitation Reports.2024; 12(1): 50.     CrossRef
  • Prospective study on ultrasound-guided stellate ganglion block improves cerebral blood flow in patients with stroke
    Lin Sun, Gu Wu, Yuan Zhou, Ansong Deng, Zongjie Chen
    Journal of Stroke and Cerebrovascular Diseases.2024; 33(4): 107593.     CrossRef
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  • Use of Bioelectrical Impedance Analysis to Explore the Effectiveness of Stellate Ganglion Block in Patients with Post-Stroke Complex Regional Pain Syndrome: A Retrospective Pilot Study
    Jin-Whan Ryu, In-Su Hwang, Seung-Kyu Lim
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    Revista Brasileira de Ortopedia.2024; 59(04): e497.     CrossRef
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    Sonal Goyal, Ajit Kumar, Manasa Kantha, Ravi Shankar Sharma, Sanjay Agrawal, Girish Kumar Singh
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    Richard Wu, Bill S. Majdalany, Meghan Lilly, J. David Prologo, Nima Kokabi
    Seminars in Interventional Radiology.2022; 39(04): 387.     CrossRef
  • Patient tolerability of suprascapular and median nerve blocks for the management of pain in post-stroke shoulder-hand syndrome
    Marc Monsour, Rosendo A. Rodriguez, Adnan Sheikh, T. Mark Campbell
    Neurological Sciences.2021; 42(3): 1123.     CrossRef
  • Effectiveness, Safety, and Predictive Potential in Ultrasound‐Guided Stellate Ganglion Blockades for the Treatment of Sympathetically Maintained Pain
    Ruben Aleanakian, Boo‐Young Chung, Robert E. Feldmann, Justus Benrath
    Pain Practice.2020; 20(6): 626.     CrossRef
  • Post-stroke complex regional pain syndrome and related factors: Experiences from a tertiary rehabilitation center
    Elif Umay Altas, Şule Şahin Onat, Hatice Ecem Konak, Cemile Sevgi Polat
    Journal of Stroke and Cerebrovascular Diseases.2020; 29(9): 104995.     CrossRef
  • Effect of Stellate Ganglion Block on Intraoperative Propofol and Fentanyl Consumption in Patients with Complex Regional Pain Syndrome Undergoing Surgical Repair of Brachial Plexus Injury: A Randomized, Double-blind, Placebo-controlled Trial
    Vanitha Rajagopalan, RajendraSingh Chouhan, MihirPrakash Pandia, Ritesh Lamsal, ParmodKumar Bithal, GirijaPrasad Rath
    Neurology India.2020; 68(3): 617.     CrossRef
  • A Randomized Comparison between 4, 6 and 8 mL of Local Anesthetic for Ultrasound-Guided Stellate Ganglion Block
    Yongjae Yoo, Chang-soon Lee, Yong-Chul Kim, Jee Youn Moon, Roderick J. Finlayson
    Journal of Clinical Medicine.2019; 8(9): 1314.     CrossRef
  • Treatment of complex regional pain syndrome: an updated systematic review and narrative synthesis
    Silvia Duong, Daniela Bravo, Keith J. Todd, Roderick J. Finlayson, De Q. Tran
    Canadian Journal of Anesthesia/Journal canadien d'anesthésie.2018; 65(6): 658.     CrossRef
  • Effects on hemodynamic variables and echocardiographic parameters after a stellate ganglion block in 15 healthy volunteers
    Katia Puente de la Vega Costa, Miquel A. Gómez Perez, Cristina Roqueta, Lorenz Fischer
    Autonomic Neuroscience.2016; 197: 46.     CrossRef
  • Local anaesthetic sympathetic blockade for complex regional pain syndrome
    Neil E O'Connell, Benedict M Wand, William Gibson, Daniel B Carr, Frank Birklein, Tasha R Stanton
    Cochrane Database of Systematic Reviews.2016;[Epub]     CrossRef
  • Stellate Ganglion Block for Painful Congenital Venous Malformation of the Arm
    Adam Woo, Liza Tharakan, Razvan Vargulescu
    Pain Practice.2015;[Epub]     CrossRef
  • Ultrasound-Guided Stellate Ganglion Blocks Combined with Pharmacological and Occupational Therapy in Complex Regional Pain Syndrome (CRPS): A Pilot Case SeriesAd Interim
    Karin Wei, Robert E. Feldmann, Anne-Kathrin Brascher, Justus Benrath
    Pain Medicine.2014; 15(12): 2120.     CrossRef
  • Ultrasound Guided Stellate Ganglion Block in Postmastectomy Pain Syndrome: A Comparison of Ketamine versus Morphine as Adjuvant to Bupivacaine
    Ola T. Abdel Dayem, Mostafa M. Saeid, Olfat M. Ismail, Adel M. El Badrawy, Nevert A. Abdel Ghaffar
    Journal of Anesthesiology.2014; 2014: 1.     CrossRef
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  • 27 Crossref
Predicting the Effect of Stellate Ganglion Block on the Lymphoscintigraphic Findings for Lymphedema in Post-Mastectomy Patients.
Kim, Hye Ri , Kim, Keewon , Kim, Ho Geun , Lim, Chai Young , Chun, Se Woong , Seo, Kwan Sik
J Korean Acad Rehabil Med 2011;35(2):214-223.
Objective
To evaluate the effect of stellate ganglion block (SGB) on the lymphoscintigraphic findings in patients with secondary lymphedema after breast cancer treatment. Method Fourteen patients were included in this retrospective study. Consecutive SGBs were performed three times, once every two weeks. The parameters for the lymphoscintigraphic findings included the extent of dermal backflow (small extent/large extent group), the presence of a washout pattern (washout/non-washout group) and visualization of lymph nodes on the 3-hour image (visualized/non-visualized group). The upper arm and forearm circumferences were used as the outcome parameters. We investigated the relationship between the lymphoscintigraphic findings and the arm circumferences. Results Regardless of the extent of dermal backflow, significant decreases of the upper arm and forearm circumferences were observed between the initial and final follow-up data. The small extent group showed a significant decrease of the forearm circumference at the first follow-up. The large extent group showed a pattern of significant decrease of the forearm circumference since the second follow-up. The washout group showed a decrease in both the upper arm and forearm circumferences, while the non-washout group showed a decrease only in the forearm circumference at the last follow-up. No difference was observed between the visualized and the non-visualized group. Conclusion The extent of dermal backflow and the presence of a washout pattern on lymphoscintigraphy showed correlation with the change of arm circumference. Lymphoscitigraphy prior to performance of SGB for lymphedema patients might be helpful to predict the outcome of SGB.
  • 1,754 View
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Clinical Outcomes of Cervical Stellate Ganglion Block in Patients with Secondary Lymphedema: A Pilot Study.
Kim, Ho Geun , Kim, Keewon , Seo, Han Gil , Im, Chae Young , Kim, Tae Uk , Chung, Sun Gun , Noh, Dong Young , Seo, Kwan Sik
J Korean Acad Rehabil Med 2009;33(3):297-303.
Objective
To investigate the clinical effect of stellate ganglion block in patients with secondary lymphedema after breast cancer treatment. Method: In a prospective clinical trial, the consecutive stellate ganglion block (SGB) was performed every two weeks to 10 patients (Mean age 46.0±9.4 (yr)) who was diagnosed as of secondary lymphedema after breast cancer treatment. The parameters were the circumstance of arm and the thickness of skin and subcutaneous tissue of the affected arm measured by ultrasonography. We measured these parameters with baseline value before SGB treatment and repeated the evaluation after each SGB treatment. And the subjective data of satisfaction, softness and improvement were obtained by questionnaires. Results: 10 patients were treated with stellate ganglion block. The mean circumferences of upper arm and forearm after three consecutive SGB treatments reduced significantly: upper arm from 31.39 cm to 29.72, forearm from 25.14 cm to 23.64 cm (p<0.05). And the thickness of subcutaneous tissue of upper arm significantly decreased under no- compression measuring technique after three SGB treatments (p<0.05). The compliance of superficial tissue showed significant change with serial procedure. Almost all of the patients had a satisfaction and feeling of softness in their affected arm after treatments. Conclusion: The cervical stellate-ganglion block reduced the circumstance and the thickness of arm with lymphedema and satisfied almost lymphedema patients. So this treatment presents a favorable outcome to the breast cancer-related lymphedema patient clinically. (J Korean Acad Rehab Med 2009; 33: 297-303)
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The Comparision of Effects between Stellate Ganglion Block and Oral Corticosteroid Therapy in Post-stroke Complex Regional Pain Syndrome.
Lim, Kil Byung , Lee, Hong Jae , Joo, Sung Joo , Kim, Jin Young , Lim, Sung Shick
J Korean Acad Rehabil Med 2007;31(4):417-422.
Objective
To compare the therapeutic effects between stellate ganglion block and steroid therapy in post-stroke complex regional pain syndrome. Method: In this controlled study, thirty-eight patients with post-stroke complex regional pain syndrome were randomly divided into two groups. One group received a total of five repeated stellate ganglion block every three days and the other group received an oral corticosteroid therapy. Therapeutic effects were assessed before treatment, after fifteen days and thirty days in the each group and evaluated via volume of the involved hand, circumference of the middle finger, shoulder and hand pain score. Results: In both groups, hand edema and circumference of middle finger were decreased after fifteen days and thirty days of treatment. However, the stellate ganglion block group showed more significant improvement in mean change of hand edema and circumference compared to the steroid therapy group. The hand and shoulder pain were also decreased significantly after fifteen days in both groups. In stellate ganglion block group, patients' pain kept decreased even after thirty days had passed since the treatment. However, in the other group who got the steroid therapy, there was no further decrease from the fifteenth day after the therapy. Conclusion: Although both treatment were effective in relieving symptoms of post-stroke complex regional pain syndrome, the stellate ganglion block was more effective. However, further controlled study is required. (J Korean Acad Rehab Med 2007; 31: 417-422)
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Case Report

Increased Blood Pressure and Loss of Consciousness after Stellate Ganglion Block: A case report.
Kim, Young gene , Han, Sang jin , Choi, Ki seob , Lee, Kyu hoon
J Korean Acad Rehabil Med 2005;29(4):434-437.
A 59 year-old female patient suffered from complex regional pain syndrome in left hemiplegia, was managed to stellate ganglion block (SGB) with 5 ml of 1 % lidocaine. The SGB was performed twice previously, with no side effects. And the third SGB was done in the same manner after negative aspiration testing. Two minutes later, she developed respiratory difficulty with increased blood pressure. Immediately airway management was performed by mask ventilation with oxygen. But ten minutes later, she developed respira-tory arrest with unconsciousness and intubation was performed. Soon she recovered spontaneous respiration and the blood pressure returned to the former level. Despite taking all precautions during SGB, complications such as respiratory arrest and hypertension may occur even in the hands of an experienced physician. Therefore, before starting SGB, all resuscitation drugs and equipment must be ready for use in case any emergency develops. (J Korean Acad Rehab Med 2005; 29: 434-437)
  • 1,630 View
  • 6 Download
Original Articles
Clinical Analysis on the Efficacy of Stellate Ganglion Block in the Patients with Cervical Herniated Intervertebral Disc.
Lee, Yang Gyun , Kim, Sang Cheol , Kim, Soo A , Kim, Min Sung , Choi, Eun
J Korean Acad Rehabil Med 2002;26(5):567-570.

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)

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The Effects of Stellate Ganglion Block in Adhesive Capsulitis of the Shoulder.
Cha, Sang Min , Kim, Hee Sang , Ahn, Kyung Hoi
J Korean Acad Rehabil Med 1998;22(4):950-954.

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.

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Sympathetic Skin Responses after Stellate Ganglion Block in the Patient with Reflex Sympathetic Dystrophy.
Park, Jeong Mee , Ahn, Juhn , Park, Roh Wook
J Korean Acad Rehabil Med 1998;22(3):610-617.

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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