Tonic-clonic seizure during the ultrasound-guided stellate ganglion block because of an injection into an unrecognized variant vertebral artery: A case report

Safety of local anesthetics in cervical nerve root injections: a narrative review

Severe neurological adverse events have been reported after fluoroscopically guided cervical nerve root injections. Particulate corticosteroids inadvertently injected intraarterially and iatrogenic vertebral artery trauma have been implicated in these outcomes. This has raised concern for the potential consequences of including local anesthetic with these injections. As a result, some providers have now discontinued the routine administration of local anesthetic with corticosteroid when performing cervical nerve root injections. At present, there is no consensus regarding whether the use of local anesthetic in this context is safe. Here, the current literature is synthesized into a narrative review aiming to clarify current perspectives of the safety of local anesthetics in cervical nerve root injections.

Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound

Objective

This study aimed to investigate the effects of stellate ganglion block (SGB) through different approaches under guidance of ultrasound.

Methods

A total of 130 patients undergoing SGB in our hospital between February 2019 and February 2020 were enrolled as the research subjects. According to the random number table method, these subjects were divided into two groups: a modified 6th cervical vertebra (C6) group (n = 65) and a 7th cervical vertebra (C7) group (n = 65). Under the guidance of ultrasound, the subjects in the modified C6 group were punctured at the level of the C6 transverse process, and the subjects in the C7 group were punctured at the level of the C7 transverse process. The operation duration, number of puncture angle adjustments, block effects, and adverse reactions for SGB were compared between the two groups.

Results

The modified C6 group showed shorter SGB operation duration and a lower number of puncture angle adjustments than the C7 group, and the differences were statistically significant (P < 0.05). Horner Syndrome occurred in both groups after SGB. The incidence of adverse reactions in the modified C6 group was 4.62%, comprising 1 case of hoarseness and 2 cases of slowed pulse, while that in the C7 group was 6.15%, with 1 case of hoarseness and 3 cases of slowed pulse; the difference between the two groups was not statistically significant (P > 0.05).

Conclusion

The operation duration for modified SGB guided by ultrasound puncturing at the C6 transverse process is shorter and requires fewer puncture angle adjustments than puncturing at the C7 transverse process; however, there is no significant difference between the incidence of adverse reactions or the blocking effects of the two methods.

The efficacy of ultrasound-guided stellate ganglion block in alleviating postoperative pain and ventricular arrhythmias and its application prospects

Stellate ganglion block (SGB) has been applied in clinic for almost a century as a therapeutic procedure to alleviate pain-related syndromes and vascular deficits in the upper extremities. A great number of causative side effects and complications due to technological insufficiency and anatomical variations called for the popularity of ultrasound-guided SGB which has made tremendous contribution for clinical diagnosis and therapy, primarily in postoperative pain and cardiac and vascular disorders. This work was aimed at systematically summarizing the current clinical application of ultrasound-guided SGB and putting forward the potential prospective application in future. By searching ultrasound-guided SGB-related works on PubMed database, we mainly elucidated the analgesic effect of preoperative SGB in patients undergoing surgical procedures and substantial reduction in patients with ventricular arrhythmias. The volume of local anesthetics used in ultrasound-guided SGB has been diminished in the recent few years' investigations and successful operation of ultrasound-guided SGB could be achieved with minimal safe volume of local anesthetics. This invasive and safe procedure shows vast potential for future development in clinical treatment for autonomic nervous system and autoimmune disorders. We also put forward hypothesis that ultrasound-guided SGB could be applied combined with controlled hypotension to reduce the intraoperative complications in orthopedic surgery such as insufficiency of cerebral blood flow and reflexive tachycardia. Thus, it is of vital essence to improve the professional skills of physicians for the high rate of success and explore more effective measures which could enhance therapeutic effects when combined with ultrasound-guided SGB in alleviating misery of patients.

Comparison of analgesic effects and postoperative cognitive function following total knee arthroplasty: continuous intravenous infusion of fentanyl vs. ultrasound-guided continuous femoral nerve block with ropivacaine

OBJECTIVE

The purpose of this study was to compare the effects of continuous intravenous infusions (CII) of fentanyl by pumping and ultrasound-guided continuous femoral nerve block (CFNB) with ropivacaine in terms of analgesic effects and postoperative cognitive function following total knee arthroplasty.

METHODS

The clinical data of 103 patients who underwent total knee arthroplasty were collected retrospectively and divided into group A (n = 51) receiving CII of fentanyl by pumping and group B (n = 52) receiving CFNB with ropivacaine. Mini-Mental State Examination (MMSE) scores, Visual analog scale (VAS) scores, knee joint flexion angle (KJFA), muscle strength, postoperative cognitive dysfunction (POCD), patient satisfaction, and adverse reactions of the two groups were compared.

RESULTS

The muscle strength scores in group B gradually improved at 6-48 h as compared with at 4 hours after operation (P < 0.05). Compared with group A, patients in group B had greater active motion of KJFA at 4, 6, and 12 h after operation (P < 0.05). In contrast to group A, patients in group B had lower VAS scores at rest or active and passive motion at 4-48 h after operation (P < 0.05). The MMSE scores of group B were higher than those of group A at 1, 4, and 7 d after operation (P < 0.05). The incidence of POCD at 4 d after operation was 1.92% in group B, lower than that of 15.69% in group A (P < 0.05). The incidence of adverse reactions was 5.77% in group B, lower than that of 29.41% in group A (P < 0.05). The satisfaction scores of group B were higher than those of group A (P < 0.05).

CONCLUSION

Compared with CII of fentanyl by pumping, ultrasound-guided CFNB showed superior analgesic effects following total knee arthroplasty, which should reduce the incidence of POCD and adverse reactions.

Stellate ganglion block combined with intra-arterial treatment: a "one-stop shop" for cerebral vasospasm after aneurysmal subarachnoid hemorrhage-a pilot study

PURPOSE

Delayed cerebral ischemia (DCI) is a frequent cause of morbidity and mortality in patients with cerebral vasospasm (CV) following aneurysmal subarachnoid hemorrhage (aSAH). Refractory CV remains challenging to treat and often leads to permanent deficits and death despite aggressive therapy. We hereby report the feasibility and safety of stellate ganglion block (SGB) performed with a vascular roadmap-guided technique to minimize the risk of accidental vascular puncture and may be coupled to a diagnostic or therapeutic cerebral angiography.

METHODS

In addition to a detailed description of the technique, we performed a retrospective analysis of a series of consecutive patients with refractory CV after aSAH that were treated with adjuvant roadmap-guided SGB. Clinical outcomes at discharge are reported.

RESULTS

Nineteen SGB procedures were performed in 10 patients, after failure of traditional hemodynamic and endovascular treatments. Each patient received 1 to 3 SGB, usually interspaced by 24 h. In 4 patients, an indwelling microcatheter for continuous infusion was inserted. First SGB occurred on average 7.3 days after aSAH. SGB was coupled to intra-arterial nimodipine infusion or balloon angioplasty in 9 patients. SGB was technically successful in all patients. There were no technical or clinical complications.

CONCLUSION

Adjuvant SGB may be coupled to endovascular therapy to treat refractory cerebral vasopasm within the same session. To guide needle placement, using a roadmap of the supra-aortic arteries may decrease the risk of complications. More prospective data is needed to evaluate the therapeutic efficacy, durability, and safety of SGB compared with the established standard of care.