Ultrasound guided versus fluroscopic guided pulsed radiofrequency therapy of the stellate ganglion in neuropathic pain: A prospective controlled comparative study

Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article

“…Some additional studies are also worth mentioning that did not fall within the aforementioned types of pain. Forouzanfar [78]. Similar significant reductions relative to baseline in VAS as well as morphine and pregabalin consumption were seen in both groups after 3 months [78].…”

“…Forouzanfar [78]. Similar significant reductions relative to baseline in VAS as well as morphine and pregabalin consumption were seen in both groups after 3 months [78]. Additionally, Ding et al compared the combined use of chemical neurolysis via anhydrous ethanol and CRF to these treatments alone applied to the lumbar sympathetic ganglia at the L2 and L3 vertebral levels for lower extremity painful diabetic peripheral neuropathy in a randomized controlled trial [79].…”

“…The vast majority of studies included in this review utilized fluoroscopic guidance. However, ultrasound [35,77,78] and CT [33] proved useful in navigating anatomic structures surrounding the stellate ganglion. Furthermore, endoscopic ultrasound [71,74] and endovascular [66] approaches are useful for reaching the celiac plexus, as opposed to percutaneous methods used at other SNS sites.…”

“…Complications can be broken down into puncture-related (non-neuropathic) pain, infection, bleeding, neurogenic complications, and systemic complications. Puncture-related pain was localized to the injection site and resolved relatively quickly [29,65,78,81]. A short-lived infection was only reported in one study, which investigated RF of the ganglion impar [40].…”

“…Bleeding was reported only at superiorly located SNS sites (stellate ganglion and sphenopalatine ganglion) and included either a local bleed (epistaxis) [51] or hematoma formation at the puncture site [34,78], in the cheek [51] or in the prevertebral region [33]. Neurogenic complications included neuropathic pain (post-sympathectomy neuralgia [28], paresthesia [29,50], and regional pain [65,84]) and non-pain-related complications (hypoesthesia [51,73], Horner's syndrome [33], ptosis [77], and off-target nerve lesions [51] using CRF and voice hoarseness using PRF [78]). Of note, Horner's syndrome [33] and ptosis [77] occurred exclusively after targeting the stellate ganglion.…”