A lateral paracarotid approach for ultrasound-guided stellate ganglion block with a linear probe

Abstract

Recent reports suggest that ultrasound-guided stellate ganglion block (SGB) is safer and more accurate than classic SGB by the using the surface anatomical landmark. However, previous reports concern the classic paratracheal approach using a small specialized curved probe, which may not be appropriate in some patients. The authors have attempted several approaches, including paratracheal, trans-thyroidal, lateral paracarotid, and lateral approaches, to find a safe and suitable method for real-time ultrasound-guided SGB using a standard high-frequency linear probe. A total of 27 injections were performed on 27 patients with sensorineural hearing loss. The lateral paracarotid out-of-plane and lateral in-plane approaches were identified as the easiest and safest methods among the four tested. In this report, we describe a new lateral paracarotid approach for ultrasound-guided SGB. An ipsilateral paratracheal short-axis transverse scan was acquired at the C6 level with a linear probe (6-13 MHz). The probe was moved laterally, scanning the thyroid, carotid artery, internal jugular vein, longus colli muscle, and the transverse process of the C6, placing the carotid artery in the middle of the view. Light pressure was applied to the probe postero-medially to displace the carotid artery medially and completely compress the internal jugular vein. The needle was inserted out-of-plane between the lateral margin of the carotid artery and Chassaignac's tubercle, traversing the collapsed internal jugular vein, and targeted between the longus colli muscle and the prevertebral fascia. A total of 4 ml of 0.2% ropivacaine was injected for each procedure after a negative aspiration test. Successful blockade was confirmed with the onset of Horner's sign. All 27 injections resulted in successful blockade with Horner's sign presenting within 5 min after injection. Side effects were minor and caused minimal discomfort; they included hoarseness and a foreign body sensation. No hematomas formed after any injections. We suggest that this new lateral paracarotid approach, with out-of plane needle insertion at the C6 tubercle under transverse scan, is a convenient and safe method for performing real-time ultrasound-guided SGB, as it provides a wide, safe space for needle passage without risking thyroid or esophageal injury.

<p>Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review</p>

“…12 Ultrasound guidance could improve the accuracy of local anesthetic injection into target site. 15,16 The use of ultrasound-guided in the index case it apparently helpful in achieving therapeutic action.…”

“…Briefly, 2-mL 2% lidocaine was injected between the internal carotid artery and the longus colli at the C7 level under ultrasound guidance ( Figure 2). 15,16 The block was repeated once every day, and the pain subsided rapidly in both intensity and frequency along with the advancement of daily treatment. On the seventh day after treatment initiation, the patient no longer had pain episode.…”

Comparison of ultrasound-guided stellate ganglion block at 6th and 7th cervical vertebrae using the lateral paracarotid out-of-plane approach for sympathetic blockade in the upper extremity

“…Ultrasound-guided SGB has several advantages, including safety, rapid onset of Horner’s sign and lower volumes of local anesthetic, compared with the landmark technique [1,4,17]. Authors have already reported that the lateral paracarotid out-of-plane approach (Song’s technique) for real-time ultrasound-guided SGB at C6 is a safe and suitable method [3,4]. Lee et al reported that a 2mL dose was sufficient for successful SGB when performing ultrasound-guided SGB at C6 [18].…”

“…For SGB at C6, a lateral paracarotid out-of-plane approach was performed for ultrasound-guided SGB (Fig. 1) [3,4]. A total of 4mL of 0.2% ropivacaine was injected to achieve blockade.…”

“…Recent reports have suggested that ultrasound-guided SGB is a safer and more accurate method [1,2]. Furthermore, our previous papers including Kim et al and Jung et al reported that a lateral paracarotid out-of-plane approach (Song’s technique) for real-time ultrasoundguided SGB using a standard high-frequency linear probe is a safe and suitable method [3,4]. However, the classical blind technique of SGB performed at C6 is less effective for sympathetic blockade of the upper extremity [5,6].…”