The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand*1

Stevens, Rosemary; Stotz, A.; Kao, Tzu‐Cheg; Powar, M.; Burgess, S.; Kleinman, Bruce

doi:10.1016/s1098-7339(98)90053-0

Cited by 26 publications

(15 citation statements)

References 19 publications

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“…was observed following successful sympatheticolysis. [26–28] There are clinical reports of pre-emptive STGB to increase the patency of radial artery grafts in coronary artery bypass surgery[29] and as an indication for the treatment of refractory angina. [30] There are few studies to demonstrate the effect of ketamine on microcirculation when added to sympathetic blockade with LA agents.…”

Section: Discussionmentioning

confidence: 99%

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

2010

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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.

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Section: Discussionmentioning

confidence: 99%

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

2010

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“…Stellate ganglion block is considered successful if resultant symptoms and signs, such as Horner's syndrome (ptosis, miosis, sclera and conjunctival injection) and increase of the skin temperature at the ipsilateral side, develop [9,10]. These clinical evaluations are commonly used in clinical practice to distinguish a successful SGB.…”

Section: Discussionmentioning

confidence: 99%

The Change in Regional Cerebral Oxygen Saturation after Stellate Ganglion Block

et al. 2010

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BackgroundStellate ganglion block (SGB) is known to increase blood flow to the innervations area of the stellate ganglion. Near infrared spectroscopy reflects an increased blood volume and allows continuous, non-invasive, and bedside monitoring of regional cerebral oxygen saturation (rSO2). We investigated the influence of SGB on bilateral cerebral oxygenation using a near infrared spectroscopy.MethodsSGB was performed on 30 patients with 1% lidocaine 10 ml using a paratracheal technique at the C6 level and confirmed by the presence of Horner's syndrome. The blood pressure (BP), heart rate (HR) and rSO2 were measured before SGB and 5, 10, 15 and 20 minutes after SGB. Tympanic temperature of each ear was measured prior to SGB and 20 minutes after SGB.ResultsThe increments of the rSO2 on the block side from the baseline were statistically significant at 5, 10, 15 and 20 minutes. The rSO2 on the non-block side compared with the baseline, however, decreased at 15 and 20 minutes. The difference between the block and the non-block sides was significant at 15 and 20 minutes. The BP at 10, 15 and 20 minutes was increased and the HR was increased at 10 and 15 minutes.ConclusionsWe observed an increment of the rSO2 on the block side from the baseline; however, the rSO2 on the non-block side decreased.

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“…If we achieve the maximum change of Ts, it can promise the complete sympathectomy, and Stevens et al [13] suggested that the maximum increase in Ts after the stellate ganglion block was predictive of a complete sympathectomy of the hand. Park et al [14] concluded that the presence of the point of temperature change of 0.4℃ per minute would be used as an indicator of the onset of the successful LSGB without additional cost and time.…”

Section: Discussionmentioning

confidence: 99%

“…Subjective measures include pain relief, warmth, changes in skin color, and anhidrosis. Objective tests include measurements of skin temperature (Ts) and blood flow, provocative sweat tests, and sympathetic skin response tests [7,8]. In this study, we compared the effect of sympathetic block between these two methods by the changes of Ts.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Multilevel with Single Level Injection during Lumbar Sympathetic Ganglion Block: Efficacy of Sympatholysis and Incidence of Psoas Muscle Injection

Hong

2010

Korean J Pain

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BackgroundWe prospectively evaluated the incidence and possible factors causing intramuscular injection during lumbar sympathetic ganglion block and compared the multiple needle technique to the single technique to obtain a profound and complete block effect.MethodsAmong 83 patients, 58 patients (group A, n = 27, multiple needle technique and group B, n = 31, single needle technique) were reevaluated for the changes of skin temperature (Ts) and mean segment of longitudinal contrast spread. After injecting the contrast agent, the incidence of psoas muscle injection and the change of Ts was compared between two groups.ResultsThe incidence of psoas muscle injection was 21.3% (46/216) and it was associated with the level of injection (L2) significantly (χ2 = 14.773, P = 0.001). DTpost (postblock temperature difference between ipsilateral and contralateral great toe, 4.6 ± 2.8℃, 1.8 ± 1.6℃, P < 0.001 for group A and B) and DTnet (DTpost - DTpre, 3.9 ± 2.7℃, 1.5 ± 1.5℃, P < 0.001 for group A and B) was significantly higher in group A. The mean segment of longitudinal contrast spread was 8.1 ± 0.9 for group A and 3.2 ± 1.6 for group B (P < 0.001).ConclusionsThe LSGB at the L2 level showed the lowest incidence of psoas muscle injection of contrast. Multiple needle approach showed more significant increase of DTnet and DTpost.

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The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand*1

Cited by 26 publications

References 19 publications

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

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

The Change in Regional Cerebral Oxygen Saturation after Stellate Ganglion Block

Comparison of Multilevel with Single Level Injection during Lumbar Sympathetic Ganglion Block: Efficacy of Sympatholysis and Incidence of Psoas Muscle Injection

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