Efficacy of stellate ganglion block with an adjuvant ketamine for peripheral vascular disease of the upper limbs

Abstract

Stellate ganglion block (STGB) is commonly indicated in painful conditions like reflex sympathetic dystrophy, malignancies of head and neck, Reynaud’s disease and vascular insufficiency of the upper limbs. The sympathetic blockade helps to relieve pain and ischaemia. Diagnostic STGB is usually performed with local anaesthetics followed by therapeutic blockade with steroids, neurolytic agents or radiofrequency ablation of ganglion. There is increasing popularity and evidence for the use of adjuvants like opioid, clonidine and N Methyl d Aspartate (NMDA) receptor antagonist – ketamine – for the regional and neuroaxial blocks. The action of ketamine with sympatholytic block is through blockade of peripherally located NMDA receptors that are the target in the management of neuropathic pain, with the added benefit of counteracting the “wind-up” phenomena of chronic pain. We studied ketamine as an adjuvant to the local anaesthetic for STGB in 20 cases of peripheral vascular disease of upper limbs during the last 5 years at our institution. STGB was given for 2 days with 2 ml of 2% lignocaine + 8 ml of 0.25% bupivacaine, followed by block with the addition of 0.5 mg/kg of ketamine for three consecutive days. There was significant pain relief of longer duration with significant rise in hand temperature. We also observed complete healing of the gangrenous fingers in 17/19 patients.

Sympathetic ganglion transcutaneous electrical nerve stimulation after coronary artery bypass graft surgery improves femoral blood flow and exercise tolerance

“…Improvement in segmental blood flow by sympathetic nerve outflow modulation has been successfully reached by regional sympathetic blockade, either invasively or noninvasively (e.g., TENS) (4). The stellate ganglion, in particular, can be selectively blocked to temporarily eliminate unilateral sympathetic innervation of the head, neck, and upper extremity (4,21). In fact, this procedure reduced sympathetic outflow and improve blood flow by up to 50% in patients with peripheral vascular disease (2).…”

Stellate Ganglion Block for Painful Congenital Venous Malformation of the Arm

“…Its growing use in anesthesia, intensive care, and pain medicine is contributed to by the ubiquitous presence of ultrasound probes in clinical areas and low side effect profile when compared to fluoroscopic or blind techniques and the absence of ionizing radiation . Local anesthetics and corticosteroids are typical agents, and additional adjuvants have been proposed to improve analgesia and prolong its effects …”

Microvascular disturbance after radial artery catheterizations in a patient with polycythemia vera

“…It also helps control pain caused by vascular disease in the upper extremitiy. 9 In this case, a total of 10 SGBs were performed, and the patient had pain relief. If the effectiveness of other treatments is poor, surgical treatment such as thrombectomy or angioplasty may be necessary.…”