Intravenous regional block is similar to sympathetic ganglion block for pain management in patients with complex regional pain syndrome type I

Sympathetic ganglion block (SGB) or intravenous regional block (IVRB) has been recommended for pain management in patients with complex regional pain syndrome type I (CRPS-I). Forty-five patients were initially selected but only 43 were accepted for the study. The present study evaluated the efficacy of IVRB produced by combining 70 mg lidocaine with 30 µg clonidine (14 patients, 1 male/13 females, age range: 27-50 years) versus SGB produced by the injection of 70 mg lidocaine alone (14 patients, 1 male/13 females, age range: 27-54 years) or combined with 30 µg clonidine (15 patients, 1 male/14 females, age range: 25-50 years) into the stellate ganglion for pain management in patients with upper extremity CRPS-I. Each procedure was repeated five times at 7-day intervals, and pain intensity and duration were measured using a visual analog scale immediately before each procedure. A progressive and significant reduction in pain scores and a significant increase in the duration of analgesia were observed in all groups following the first three blocks, but no further improvement was obtained following the last two blocks. Drowsiness, the most frequent side effect, and dry mouth occurred only in patients submitted to SGB with lidocaine combined with clonidine. The three methods were similar regarding changes in pain intensity and duration of analgesia. However, IVRB seems to be preferable to SGB due to its easier execution and lower risk of undesirable effects.

Determination of Adequate Entry Angle of Lumbar Sympathetic Ganglion Block in Korean

BACKGROUND: The target of lumbar sympathetic ganglion block is the anterolateral surface of the L2, 3 and 4 vertebral bodies, where the lumbar sympathetic ganglion usually lies. In most cases, a block-needle is inserted approximately 5-8 cm lateral to spinous process on the skin and directed to the anterolateral surface of vertebral body obliquely. The purpose of this study is to determine the safe entry angle and entry point in Korean by using the abdominal CT scan images. METHODS: The abdominal CT images of eighty five patients were recruited to this study. The minimal angle aimed at the lumbar sympathetic ganglion that can pass through the lateral aspect of body and maximal angle that avoids puncturing the kidney, ureter or retroperitoneal space were measured. The distance from midline to skin entry point was also measured. RESULTS: There was no significant difference in entry angle among L2, 3, and 4 level. The entry angle was similar in the right and left side, and in males and females. The entry angle of old age group was significantly smaller than that of young age group. The calculated safe entry angle was 30.5 +/- 0.4degrees and entry point was 7.7 +/- 0.2 cm and 6.7 +/- 0.1 cm lateral from midline in males and females respectively. CONCLUSION: These measurements can be used as a reference for lumbar sympathetic ganglion block and radiofrequency lesioning. Prior to performing the lumbar sympathetic ganglion block for cancer patients, the abdominal CT scan should be reviewed to prevent complications.

Gustatory Change after Sympathetic Ganglion Block in Complex Regional Pain Syndrome Type I Patient: A case report

Some reports provide conclusive evidence of close interactive regulation between the taste receptor and sympathetic nervous system. We report a middle-aged male patient with gustatory change after cervical sympathetic ganglion block (CSGB) who had been suffering from hypersensitivity to sour taste since developing complex regional pain syndrome (CRPS) type 1, diagnosed according to the revised CRPS criteria. Despite receiving two high doses of prednisolone therapy, he experienced the recurrence of CRPS symptoms. We attempted other therapy treatments, including pamidronate intravenous infusion, non-steroidal anti-inflammatory drugs, opioids, tricyclic antidepressants, and CSGB. Following each CSGB administration, the patient reported decreased hypersensitivity to sour-tasting foods, such as kimchi and oranges, with decreased pain and reduction of dysautonomic symptoms. This case demonstrates that overactivation of the sympathetic nervous system may influence sensitivity and regulation of gustatory receptors; therefore, a patient demonstrating CRPS symptoms, including taste alterations, may respond positively to CSGB therapy.

The Effects of Lumbar Sympathetic Ganglion Block in the Patients with Spinal Stenosis and the Skin Temperature Changes according to the Contrast Spread Patterns

BACKGROUND: We hypothesized that if a fluoroscopic image of the lumbar sympathetic ganglion block (LSGB) showed the spread patterns of contrast at both the L2/3 and L4/5 disc areas, then this would demonstrate a more profound blockade effect because the spread patterns are close to sympathetic ganglia. In addition, we compared the effects of LSGB and transforaminal epidural steroid injection (TFESI) for the patients suffering with spinal stenosis. METHODS: Eighty patients were divided into two groups (Group S: the patients treated with TFESI, Group L: the patients treated with LSGB). The patients of group L were classified into three groups (groups A, B and, C) according to their contrast spread pattern. The preblock and postblock temperature difference between the ipsilateral and contralateral great toe (DT(pre), DT(post), degrees C), and the DTnet were calculated as follows. DT(net) = DT(post) - DT(pre). RESULTS: Both group showed a significant reduction of the visual analogue score (VAS) and the Oswestry disability index (ODI) score. Only the patients of group L showed a significant increase of their walking distance (WD). Group A showed the most significant changes in the DT(post) (6.1 +/- 1.2degrees C, P = 0.021), and the DTnet (6.0 +/- 1.0degrees C, p = 0.023), as compared to group C. CONCLUSIONS: LSGB showed a similar effect on the VAS, and ODI, and a significant effect, on WD, compared with TFESI. Group A showed a significant sympatholytic effect, as compared to group C.

The Effects of Superior Cervical Sympathetic Ganglion Block on the Acute Phase Injury and Long Term Protection against Focal Cerebral Ischemia/Reperfusion Injury in Rats / 대한통증학회지

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglia (SCG), and these nerves may influence the cerebral blood flow. The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats that were subjected to focal cerebral ischemia/reperfusion injury. METHODS: Eighty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of two groups (the ropivacaine group and a control group). In all the animals, brain injury was induced by middle cerebral artery (MCA) reperfusion that followed MCA occlusion for 2 hours. The animals of the ropivacaine group received 30microl of 0.75% ropivacaine, and their SCG. Neurologic score was assessed at 1, 3, 7 and 14 days after brain injury. Brain tissue samples were then collected. The infarct ratio was measured by 2.3.5-triphenyltetrazolium chloride staining. The terminal deoxynucleotidyl transferase mediated dUTP-biotin nick-end labeled (TUNEL) reactive cells and the cells showing caspase-3 activity were counted as markers of apoptosis at the caudoputamen and frontoparietal cortex. RESULTS: The death rate, the neurologic score and the infarction ratio were significantly less in the ropivacaine group 24 hr after ischemia/reperfusion injury. The number of TUNEL positive cells in the ropivacaine group was significantly lower than those values of the control group in the frontoparietal cortex at 3 days after injury, but the caspase-3 activity was higher in the ropivacaine group than that in the control group at 1 day after injury. CONCLUSIONS: The study data indicated that a superior cervical sympathetic ganglion block may reduce the neuronal injury caused by focal cerebral ischemia/reperfusion, but it may not prevent the delayed damage.

Superior Cervical Sympathetic Ganglion Block may not Influence Early Brain Damage Induced by Permanent Focal Cerebral Ischemia in Rats / 대한통증학회지

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglion (SCG). The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats subjected to permanent focal cerebral ischemia. METHODS: Thirty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of three groups (control, lidocaine and ropivacaine). A brain injury was induced in all rats by middle cerebral artery occlusion with a nylon thread. The animals of the local anesthetic group received 30 microl of 2% lidocaine or 0.75% ropivacaine in the SCG. Neurologic scores were assessed 24 hours after brain injury. Brain samples were then collected. The infarct and edema ratios were measured by 2.3.5-triphenyltetrazolium chloride staining. RESULTS: There were no differences in the death rates, neurologic scores, or infarction and edema ratios between the three groups. CONCLUSIONS: These findings suggest that superior cervical sympathetic ganglion block may not influence the brain damage induced by permanent focal cerebral ischemia in rats.

Effect of Superior Cervical Sympathetic Ganglion Block on Brain Injury Induced by Focal Cerebral Ischemia/Reperfusion in a Rat Model / 대한통증학회지

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves that originate in the superior cervical ganglia (SCG). This study was conducted to determine the effect of an SCG block on brain injury caused by focal cerebral ischemia/reperfusion in a rat model. METHODS: Male Sprague-Dawley rats (270-320 g) were randomly assigned to one of three groups (lidocaine, ropivacaine, and control). After brain injury induced by middle cerebral artery (MCA) occlusion/reperfusion, the animals were administered an SCG bloc that consisted of 30 microliter of 2% lidocaine or 0.75% ropivacaine, with the exception of animals in the control group, which received no treatment. Twenty four hours after brain injury was induced, neurologic scores were assessed and brain samples were collected. The infarct and edema ratios were measured, and DNA fragmented cells were counted in the frontoparietal cortex and the caudoputamen. RESULTS: No significant differences in neurologic scores or edema ratios were observed among the three groups. However, the infarct ratio was significantly lower in the ropivacaine group than in the control group (P<0.05), and the number of necrotic cells in the caudoputamen of the ropivacaine group was significantly lower than in the control group (P<0.01). Additionally, the number of necrotic and apoptotic cells in theropivacaine group were significantly lower than inthe control group in both the caudoputamen and the frontoparietal cortex (P<0.05). CONCLUSIONS: Brain injury induced by focal cerebral ischemia/reperfusion was reduced by an SCG block using local anesthetics. This finding suggests that a cervical sympathetic block could be considered as another treatment option for the treatment of cerebral vascular diseases.

Lumbar Sympathetic Ganglion Block with Alcohol for Plantar Hyperhidrosis / 대한통증학회지

BACKGROUND: Chemical lumbar sympathetic ganglion block could potentially be used to treat plantar hyperhidrosis; therefore, we analyzed the outcome of lumbar sympathetic ganglion block using alcohol for the treatment of plantar hyperhidrosis. METHODS: Between March 1992 and June 2003, 356 patients with plantar hyperhidrosis underwent lumbar sympathetic ganglion block using alcohol. All 356 patients were followed up for 2 years and the results evaluated. There were 185 and 171 male and female patients, respectively, with a mean age of 25.1 years, ranging from 15.3 to 56.5 years old. Lumbar sympathetic ganglion block using alcohol was performed with fluoroscopic guidance under local anesthesia. RESULTS: The recurrence rate after 2 years was 34%. Compensatory hyperhidrosis, ejaculation failure, lower back pain and genitofemoral neuritis developed as complications in 132, 4, 12 and 2 patients, respectively. Of the 356 patients, 65% were satisfied. CONCLUSIONS: Lumbar sympathetic ganglion block using alcohol is an effective and safe method for the treatment of plantar hyperhidrosis, but more information about the complications and relatively high recurrence rates should be provided to the patient.

Dorsal Percutaneous Thoracic Sympathetic Ganglion Block with Alcohol for the Treatment of Palmar Hyperhidrosis / 대한통증학회지

BACKGROUND: Hyperhidrosis is the troublesome disorder of excessive perspiration, which affects as much as 0.15-1% of the population. There are many methods for treating hyperhidrosis. In this report, we present our experience of dorsal percutaneous thoracic sympathetic ganglion block (TSGB) using 99.9% ethyl alcohol for treating palmar hyperhidrosis. METHODS: Between March 1992 and July 2003, a total of 856 patients underwent TSGB for the treatment of palmar hyperhidrosis of which 625 were followed up for 2 years. There were 297 and 328 male and female patients, respectively, with a mean age of 23.9+/-7.7 years. TSGB was performed under fluoroscopic guidance using 99.9% ethyl alcohol at the T2 and T3 sympathetic ganglia. RESULTS: In the 625 patients, the recurrence rates within the 1st and 2nd years were 29 and 8%, respectively. Compensatory sweating occurred in 42.1% of patients, which was severe in 7.5%. Of the 625 patients 21.0 and 36.9% were either very satisfied or relatively satisfied with the outcome, respectively. CONCLUSIONS: Our report confirms that TSGB may be a good alternative to endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis.

A Review of Insertion Site for Lumbar Sympathetic Ganglion Block / 대한마취과학회지

BACKGROUND: Lumbar sympathetic ganglion block (LSGB) is one of the most frequently performed blocks in the field of interventional pain management. However, several complications can be expected if pain clinicians do not have a through understanding of radiological anatomy and current technique for locating block, landmarks are poor. Therefore, we devised a simple, safe, and patient tolerable block technique. METHODS: We selected patients scheduled for a LSGB with a body mass index of less than 25 kg/m2. After prone positioning, C-arm projection was adjusted obliquely until the tip of the L3 transverse process met the lateral margin of the corresponding vertebral body. Maintaining this angle, the skin entry point was determined at the lower one-third of the lateral margin of the vertebral body. We measured the distance from the mid-point of the spinous process to the skin entry point. A curved block needle was advanced using the tunnel vision technique, until the needle tip touched the lateral margin of the vertebral body. We also measured the position of the needle tip relative to the vertebral body in the lateral projection of the C-arm (lateral width percentage). Thereafter, the needle was slid along the lateral margin of the vertebral body to the anterior margin. RESULTS: The distance from the mid-point of the spinous process to the skin entry point was 6.5 +/- 1.0 cm. The angle of the C-arm projection was 22.0 +/- 3.8o. The depth from the skin entry point to the needle tip when touching the lateral margin of the vertebral body in the oblique projection of the C-arm was 8.5 +/- 0.9 cm. The lateral width percentage from the posterior margin of vertebral body was 49.0 +/- 7.0% and the entire depth of the curved needle from the skin entry point to the anterior margin of the vertebral body was 10.4 +/- 1.0 cm. CONCLUSIONS: This simple tunnel vision technique using a curved needle and an oblique C-arm projection is safe, simple and patient tolerable. In addition, it reduces block time and avoids repeated needle insertions. The tip of the L3 transverse process and the lateral margin of the corresponding vertebral body were found to be useful bony landmarks for the block. We believe that the provided depths and lateral width percentages may be useful for block in Koreans.

Infrared Thermographic Imaging in the Assessment of Successful Block on Lumbar Sympathetic Ganglion

This study examined the net changes in temperature at various regions of the lower extremities in an attempt to identify the regions demonstrating the most significant temperature changes following a lumbar sympathetic ganglion block (LSGB). Thermography was performed before and after the LSGB in 26 sympathetic nerve system disorder cases. The inspection points were the anterior and posterior surfaces of the thigh, the knee and leg, and the dorsal and plantar surfaces of the feet. The net increases in skin temperature following the LSGB (deltaT (net) ) at the plantar and dorsal surfaces of the feet, were 6.2 +/- 2.68 degrees C (mean +/- SD) and 3.9 +/- 1.89degrees C, respectively, which were higher than those observed in the other regions of the lower extremities (p < 0.05). The areas, in order of decreasing deltaT (net), are as follows: the plantar surface of the foot, the dorsal surface of the foot, the shin, the anterior surface of the knee, the calf, the posterior surface of the knee, the anterior surface of the thigh, and the posterior surface of the thigh. There was one case of orthostatic hypotension during the thermography procedure. In conclusion, thermographic imaging is a useful method for demonstrating the success of a LSGB in various diseases. An evaluation of the deltaT (net) on the plantar surface of the feet using thermographic imaging is the most effective, simple, and safe method for assessing a successful LSGB.

The Effects of Stellate Ganglion Block on Measurement with A Neurometer and An Electrodermometer / 全日本鍼灸学会雑誌

It is said that Ryodoraku reflects the dysfunction of the autonomic nerve in spite of no objective evidence for the theory.<br>Using 60 patients received right stellate ganglion block, we measured 24 typical determinate points of ryodoraku with a neurometer and an electrodermometer.<br>With a neurometer, an average current value of 6 points of the right upper extremity decreased in 52% as well as that of 6 points of the left decreased in 62%. Both the right and the left lower extremities decreased in 91% and 85%.<br>With an electrodermometer, the average impedance of the right upper extremity increased in 108%.<br>Finally, the sympathetic blockade showed decrease in a current value with a neurometer and increase in impedance with an electrodermometer.