An unusual complication after stellate ganglion block by the paratracheal approach: A case report

Abstract

Tlax VA~TaACHEAL AVPROACH for blockade of the stellate ganglion has been recommended as the safest route 1 because of its technical simplicity and lack of complications e when low doses of local anaesthetic solutions are used. Subarachnoid block associated with infiltration of the stellate ganglion has been cited as a rare complication. 1,a-9 The evidence from the literature would suggest that the commonest cause of subarachnoid block is accidental dural puncture either by directly entering the spinal canal, particularly when the lateral or anterolateral route is employed ~ or through an abnormal dural extension through the intervertebral foramena such as cervical meningocele. 1~The case of inadvertent subarachnoid block described by Magora 6 and discussed by Moore r where the paratracheal approach was used would seem to have resulted from penetration of the subarachnoid space caused by sudden movement by the patient during injection.The use of repeated injections of the stellate ganglion in the management of intractable pain of the sympathetic dystrophic types has gained popularity during the last three decades because of the high rate of long-term remission. Serial blocks are thought to disorganize the reflex activity which is triggered in the internunceal neuronal pool of the spinal cord as well as in the sympathetics themselves. 2The following case is presented to emphasize a possible hazard of repeat stellate ganglion block by the paratracheal route. CASE REPORTA 54-year-old woman was referred to the Pain Clinic for the management of left upper limb Raynaud's phenomena complicating long-standing diabetes mellitus. A diagnosis of bilateral carpal tunnel syndrome had been made about 18 months previously and was associated with marked median nerve sensory loss with paraesthesia particularly on the left side. Left carpal tunnel decompression was performed under I.V. regional block with 1.5 per cent lidocaine, but did little to relieve her symptoms. Indeed, during the months after surgery the pain was much worse, being aggravated by cold, emotion and exercise. When she was first seen at the clinic, she had moderately severe loss of motor function of the left hand and virtually continuous pain; the left hand was also cold and pale, indicating moderate ischaemia.The patient was a fairly heavy smoker (more than 20 cigarettes per day) and

Bleeding Risk in Interventional Pain Practice: Assessment, Management, and Review of the Literature

“…Acute hematomas, causing severe airway obstruction and a locked-in syndrome, have been reported as a consequence of a stellate ganglion block (301,305). This procedure puts vital neural structures at risk as well (409)(410)(411)(412).…”