ABSTRACT
BACKGROUND AND OBJECTIVE: Bleeding into the retropharyngeal space is a potential complication in stellate ganglion block (SGB). Retropharyngeal hematoma formation is considered to be due to damage of small arteries in the region, although only scanty details of the region are available. The aim of this study was to map the risk blood vessels in the retropharyngeal space to avoid accidental damage during SGB. METHODS: Contrast-enhanced 3-dimensional computed tomography images performed on 80 patients were reanalyzed retrospectively to construct detailed map of cervical blood vessels that are prone to damage and bleeding during SGB. RESULTS: Of the 160 bilateral necks, 6 (3.8%) and 82 (51.3%) small arteries were identified in the medial portions of the ventral surface of the transverse processes of the sixth and seventh cervical vertebrae, respectively. In particular, 5 of the 6 small arteries detected in the medial portion of the ventral surface of the transverse process of the sixth cervical vertebra were the inferior thyroid artery (ITA). Of the 160 vertebral arteries, 2 arteries were missing, 4 (2.5%) entered the transverse foramen of the fifth cervical vertebra, whereas 1 artery (0.6%) entered the transverse foramen of the fourth cervical vertebra. CONCLUSIONS: Three-dimensional computed tomography identified the ITA in the medial portion of the ventral surface of the transverse process of the sixth cervical vertebra. The risk vessels of retropharyngeal hematoma during SGB could include the ITA.
Subject(s)
Autonomic Nerve Block/adverse effects , Cervical Vertebrae/blood supply , Hematoma/diagnostic imaging , Pharynx/blood supply , Stellate Ganglion/diagnostic imaging , Aged , Aged, 80 and over , Autonomic Nerve Block/methods , Cervical Vertebrae/anatomy & histology , Female , Hematoma/etiology , Humans , Male , Middle Aged , Pharynx/anatomy & histology , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Retropharyngeal hematoma (RPH) is rare; however, it causes airway obstruction and can be fatal. Stellate ganglion block (SGB) can cause RPH. The authors analyzed reports of patients with RPH after SGB to clarify the initial symptoms and signs, and the urgency of airway management. METHODS: MEDLINE and Japana Centra Revuo Medicina were searched for reports of RPH after SGB using the following terms and key words: stellate ganglion block, complication, hematoma, and retropharyngeal hematoma. RESULTS: The authors found 27 patients with RPH after SGB in the past 40 yr. The initial symptoms included neck pain (n = 10), dyspnea (n = 10), neck swelling (n = 8), and hoarseness (n = 5). The symptoms occurred 2 h or more after SGB in 14 patients (52%). Emergency airway management was needed in 21 patients (78%) because of airway obstruction. Among the 21 patients, orotracheal intubation was attempted first in 17 patients; however, it was unsuccessful in 5 patients who immediately needed emergency tracheostomy. Tracheal intubation was impossible by distortion of the anatomy of the markedly edematous pharyngolarynx. Failed airway management caused one death. There were no statistically significant predictors of the initial symptoms or signs for later emergency airway management. CONCLUSIONS: RPH after SGB necessitates emergency airway management. Because airway obstruction cannot be predicted by the initial symptoms or signs, emergency airway management tools should be at hand, and the patency of the airway should be continuously evaluated after onset of RPH after SGB.
Subject(s)
Airway Obstruction/etiology , Hematoma/etiology , Intraoperative Complications/etiology , Nerve Block/adverse effects , Pharyngeal Diseases/etiology , Stellate Ganglion , Adult , Aged , Airway Obstruction/diagnosis , Airway Obstruction/pathology , Autopsy , Blood Coagulation/drug effects , Drug Interactions , Dyspnea/etiology , Female , Hematoma/diagnosis , Hematoma/pathology , Hoarseness/etiology , Humans , Intraoperative Complications/diagnosis , Intraoperative Complications/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Neck Pain/etiology , Pharyngeal Diseases/diagnosis , Pharyngeal Diseases/pathology , Pharyngitis/etiology , Respiration, Artificial , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
BACKGROUND AND OBJECTIVE: Iodinated contrast agents are usually used to verify correct spread of injectate during splanchnic neurolysis. We performed a splanchnic neurolysis by using carbon dioxide as the contrast agent in a patient who was allergic to iodinated contrast agents. CASE REPORT: A 49-year-old man had severe upper abdominal and back pain due to chronic pancreatitis. Because slow-release morphine 360 mg a day and epidural fentanyl 500 microg a day did not relieve the pain, a splanchnic neurolysis was performed by the posterior approach. The needle tip was placed into the retrocrural space under fluoroscopic guidance. Fifteen milliliters of carbon dioxide was injected as the contrast agent. It gave a less clear image than that obtained by iodinated contrast agents; however, the correct spread of the gas was easily visible under continuous fluoroscopy. Six percent aqueous phenol 8 mL was injected after confirming relief of the pain with a local anesthetic. The dose of slow-release morphine was gradually decreased after the procedure. His abdominal and back pain was controlled with slow-release morphine 120 mg a day. CONCLUSION: Carbon dioxide was useful as the contrast agent to perform splanchnic neurolysis.
