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Deng JJ, Zhang CL, Liu DW, Huang T, Xu J, Liu QY, Zhang YN. Treatment of stellate ganglion block in diseases: Its role and application prospect. World J Clin Cases 2023; 11:2160-2167. [PMID: 37122525 PMCID: PMC10131013 DOI: 10.12998/wjcc.v11.i10.2160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
The stellate ganglion (SG), as a type of sympathetic ganglion, consists of the sixth and seventh cervical vertebrae and the first thoracic sympathetic ganglia. SG block (SGB) is a minimally invasive injection that aims to inject low-concentration local anesthetics to induce a broad sympathetic blocking effect near the SG. There have been no changes and progress in the clinical application of SGB since the 1830s due to several potential risks, including hematoma from blood vessel injury, hoarseness from recurrent laryngeal nerve injury, and cardiopulmonary arrest. The feasibility and safety of SGB have greatly improved since the appearance of ultrasound-guided SGB. In recent years, SGB has been widely applied in the field of non-anesthesiology sedation, with significant therapeutic effects on pain, immunological diseases, somnipathy, psychological disorders, arrhythmias, and endocrine diseases. The present study reviews the present application of SGB in clinical practice.
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Affiliation(s)
- Jing-Jing Deng
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
| | - Cai-Ling Zhang
- Department of Anesthesiology, Meizhou Hospital of Traditional Chinese Medicine, Meizhou 514700, Guangdong Province, China
| | - Dian-Wen Liu
- Department of Anesthesiology, Shangqiu Maternal and Children Health Care Hospital, Shangqiu 476000, Henan Province, China
| | - Tao Huang
- Department of Anesthesiology, Fengshun Hospital of Traditional Chinese Medicine, Meizhou 514700, Guangdong Province, China
| | - Jian Xu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
| | - Qing-Yan Liu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
| | - Yue-Nong Zhang
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
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Yang RZ, Li YZ, Liang M, Yu JJ, Chen ML, Qiu JJ, Lin SZ, Wu XD, Zeng K. Stellate Ganglion Block Improves Postoperative Sleep Quality and Analgesia in Patients with Breast Cancer: A Randomized Controlled Trial. Pain Ther 2023; 12:491-503. [PMID: 36652140 PMCID: PMC10036705 DOI: 10.1007/s40122-022-00473-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Postoperative impaired sleep quality and pain are associated with adverse outcomes. Stellate ganglion block (SGB) has shown promising results in enhancing sleep quality and alleviating neuropathic pain. This study aimed to investigate the effects of ultrasound-guided SGB on postoperative sleep quality and pain in patients undergoing breast cancer surgery. METHODS This study is a parallel-group randomized controlled clinical trial with two groups: SGB and control. Fifty female patients undergoing breast cancer surgery were randomized in a 1:1 ratio to receive preoperative ultrasound-guided single-injection SGB (SGB group) or just an ultrasound scan (control group). All participants were blinded to the group assignment. The primary outcome was postoperative sleep quality, assessed by the St. Mary's Hospital Sleep Questionnaire and actigraphy 2 days postoperatively. The secondary outcome was postoperative pain, measured by the visual analog scale. RESULTS A total of 48 patients completed the study, with 23 patients in the control group and 25 in the SGB group. The postoperative St. Mary's Hospital Sleep Questionnaire scores were significantly higher in the SGB group than in the control group on 1 day postoperative (30.88 ± 2.44 versus 27.35 ± 4.12 points, P = 0.001). The SGB also increased the total sleep time and sleep efficiency (main actigraphy indicators) during the first two postoperative nights. Compared with the control group, preoperative SGB reduced postoperative pain and the incidence of breast cancer-related lymphedema (20% versus 52.2%, P = 0.02, odds ratio 0.229, 95% confidence interval 0.064-0.821). There were no adverse events related to SGB. CONCLUSION Preoperative ultrasound-guided SGB improves postoperative sleep quality and analgesia in patients undergoing breast cancer surgery. SGB may be a safe and practical treatment to enhance the postoperative quality of life in patients with breast cancer. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100046620, principal investigator: Kai Zeng, date of registration: 23 May 2021).
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Affiliation(s)
- Rui-Zhi Yang
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Yan-Zhen Li
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Min Liang
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Jian-Jun Yu
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Ming-Li Chen
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Jin-Jia Qiu
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Shi-Zhu Lin
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Xiao-Dan Wu
- Department of Anesthesiology, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College, Fujian Medical University, Fuzhou, 350001, China.
| | - Kai Zeng
- Department of Anesthesiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
- Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
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Irastorza RM, Bovaira M, García-Vitoria C, Muñoz V, Berjano E. Effect of the relative position of electrode and stellate ganglion during thermal radiofrequency ablation: a simulation study. Int J Hyperthermia 2021; 38:1502-1511. [PMID: 34674597 DOI: 10.1080/02656736.2021.1974580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Stellate ganglion (SG) block by thermal radiofrequency ablation (RFA) is frequently conducted as a therapeutic intervention for sympathetic-maintained and neuropathic pain syndromes. RFA's partial lack of effectiveness could be partly due to the ablation zone (AZ) not completely covering the SG section and therefore preventing the 'cutting' of the afferent pathways. Our objective was to build a theoretical model to conduct computer simulations to assess the effect of the electrode position relative to the SG. METHODS A three-dimensional model was built including the SG and adjacent tissues (vertebrae C7-T1-T2, trachea, carotid artery and vertebral artery). RFA (90-s, 80 °C) was simulated considering a 22 G-5 mm electrode. The AZ was computed using the 50 °C isotherm. RESULTS An electrode displacement of 2 mm in any direction from the optimal position (centered on the SG) meant that the AZ did not fully cover the SG section. Likewise, SG size considerably affected the RFA effectiveness since the AZ fully covered the section of small but not large SGs. CONCLUSIONS The findings suggest that the currently used SG RFA settings (i.e., 22 G-5 mm electrode, 90-s, 80 °C) may not be appropriate due to their inability to achieve an AZ that fully covers the SG cross section under certain circumstances, such as a large SG and non-optimal positioning of the RF electrode with respect to the SG center.
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Affiliation(s)
- Ramiro M Irastorza
- Instituto de Física de Líquidos y Sistemas Biológicos (CONICET), La Plata, Argentina.,Instituto de Ingeniería y Agronomía, Universidad Nacional Arturo Jauretche, Florencio Varela, Argentina
| | - Maite Bovaira
- Department of Anesthesiology, Critical Care and Pain Management, Hospital Intermutual de Levante, Valencia, Spain
| | - Carles García-Vitoria
- Department of Anesthesiology, Critical Care and Pain Management, Hospital Intermutual de Levante, Valencia, Spain
| | | | - Enrique Berjano
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
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Interventional Therapies for Pain in Cancer Patients: a Narrative Review. Curr Pain Headache Rep 2021; 25:44. [PMID: 33961156 DOI: 10.1007/s11916-021-00963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Pain is a prevalent symptom in the lives of patients with cancer. In light of the ongoing opioid epidemic and increasing awareness of the potential for opioid abuse and addiction, clinicians are progressively turning to interventional therapies. This article reviews the interventional techniques available to mitigate the debilitating effects that untreated or poorly treated pain have in this population. RECENT FINDINGS A range of interventional therapies and technical approaches are available for the treatment of cancer-related pain. Many of the techniques described may offer effective analgesia with less systemic toxicity and dependency than first- and second-line oral and parenteral agents. Neuromodulatory techniques including dorsal root ganglion stimulation and peripheral nerve stimulation are increasingly finding roles in the management of oncologic pain. The goal of this pragmatic narrative review is to discuss interventional approaches to cancer-related pain and the potential of such therapies to improve the quality of life of cancer patients.
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