Effect of stellate ganglion block on cerebral blood velocity

Qian CHEN; Xuejun CHEN; Yanyi CEN; Yanni FU

ABSTRACT

BACKGROUND:

Stellate ganglion block (SGB) has become a technique frequently used in the field of pain management for its wide indication spectrum. Its ameliorative effect on cephal-facial pain may be achieved by regulating the cerebrovascular diastolic and systolic functions and intensifying cerebral perfusion.

OBJECTIVE:

To observe the influence of SGB on the blood velocity of anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA) and vertebral artery with three-dimensional transcranial Doppler (TCD) in patients with caphal-facial diseases caused by is chemia or vascular spasm.

DESIGN:

A before-after control observation.SETTINGS Department of Pain Management, Guizhou Provincial Orthopaedic Hospital; Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical College; Department of Anesthesiology, the Second Affiliated Hospital of Sun Yat-sen University.

PARTICIPANTS:

Twenty patients of 18-50 years old were selected from the Department of Pain Management of Guizhou Provincial Orthopaedic Hospital from March 2004 to December 2005, including 6 cases of migraine,3 of cluster headache, 4 of muscle tension-type headache, 2 of nervous tinnitus and earache, and 5 of derangement of temporomandibular joint.

METHODS:

Unilateral SGB was performed by means of paratracheal anterior technique, with the following compound prescription lidocaine (20 g/L)2.5 mL and dexamethasone 1 mg in normal saline with a total volume of 10 mL. SGB was performed once a day for 7 consecutive days as one course.MAIN OUTCOME

MEASURES:

The changes of blood velocity of ACA,MCA, PCA and vertebral artery were observed with three-dimensional TCD before SGB and at 30 minutes after SGB.

RESULTS:

All the 20 patients finished the treatment and entered the analysis of results. After treatment, the blood velocities of ACA, MCA and PCA of the blocked side were increased remarkably as compared with those before treatment [(76.20±3.83), (61.95±2.50) cm/s; (83.65±2.36),(77.55±2.69) em/s; (65.20±2.99), (58.70±2.2.35) cm/s; P ＜ 0.01], but that of vertebral artery had no significant change before and after treatment [(47.20±2.04), (45.55±2.23) cm/s, P ＞ 0.05].

CONCLUSION:

The blood velocities of the blocked side are obviously increased after treatmeut, the increased blood velocities of ACA, MCA and PCA have important clinical significance for the blood supply of cerebral hemisphere, especially the anterior 2/3 part, but had little great influence on vertebral artery, indicating that SGB has great pertinence to the caphalfacial diseases caused by ischemia or vascular spasm, and can ameliorate the cerebral blood perfusion.