An Unusual Complication of Sinus Arrest Following Right‐Sided Stellate Ganglion Block: A Case Report

Abstract

We present a case of a 29-year-old female patient who had presented to us for the management of her chronic right shoulder-hand pain and developed a sinus arrest following a right-sided stellate ganglion block (RSGB). This patient on receiving a diagnostic RSGB via the anterior paratracheal (C6) approach developed sinus arrest followed by apnea and unconsciousness. On institution of resuscitative measures involving tracheal intubation, positive pressure ventilation, cardiac massage, and intravenous atropine, spontaneous cardiac activity recovered in about 3 minutes. Other signs and symptoms resolved fully in a total of 10 minutes. She had persistent postural hypotension lasting for about 24 hours requiring bed rest and was discharged about 36 hours after the procedure, without any adverse sequelae. As the sinus node is supplied by the right-sided sympathetic chain, its blockade probably resulted in unopposed parasympathetic activity leading to asystole. Available evidence of the role of right stellate ganglion in regulation of cardiac electrophysiology and functioning is also discussed.

Complications associated with stellate ganglion nerve block: a systematic review

“…Saxena et al 55 reported a case of bradycardic cardiac arrest after a landmark-based SGNB in a 29-year-old woman for right shoulder and hand pain. The patient received an uneventful 1 mL 1.5% lidocaine test dose followed by 10 mL 1.5% lidocaine.…”

Complication belong to Stellate ganglion blockade after cervical trauma

“…[5] SGB sonrası ciddi komplikasyon oranı 1.7/1000 dir. [6] SGB'nin C6 seviyesinden yapılması, daha kolay palpe edilmesi, plevraya daha uzak olması ve vertebral arter ponksiyon riskinin daha düşük olması nedeniyle tercih edilmektedir.…”

“…Bazen yanlış negatif aspirasyon ve yanlış negatif test dozları olabildiği rapor edilmiştir. [6] Vertebral artere lokal anestezik enjeksiyonu konvülsiyon ve apne dışında bazen de, geçici göz fiksasyonu, hareket edememe ve bilinç kapanmaksızın respiratuvar distresle karakterize kilitlenme sendromu (locked-in) gibi komplikasyonlara da neden olabilir. [7,8] Bizim olgumuzda epileptik nöbetin görülmemesi intravasküler enjeksiyonu düşündürmemiştir.…”

The changes of heart rate variability after unilateral stellate ganglion block

“…Kimura et al presented a series of serious blood pressure elevations where systolic arterial pressure exceeded 200 mmHg after stellate ganglion block, likely due to local anesthetic infiltration into adjacent tissues resulting in partial block of the vagus nerve and sympathetic accentuation to trigger an increase in blood pressure [18]. Ashok et al reported cases of sinus arrest after stellate ganglion block, and suggested that sympathetic nerve block after stellate ganglion block resulted in parasympathetic accentuation to trigger asystole [19]. …”