scholarly journals Incidence of inadvertent intercostal or epidural spread during thoracic sympathetic ganglion block

2020 ◽  
Vol 15 (4) ◽  
pp. 486-491
Author(s):  
Ji Hee Hong ◽  
Seung Won Yi ◽  
Ji Seob Kim
Keyword(s):  
Sympathetic Ganglion ◽  
Pain Syndrome ◽  
Breast Cancer Surgery ◽  
Ganglion Block ◽  
Sympathetically Maintained Pain ◽  
Epidural Injections ◽  
Close Proximity ◽  
High Incidence ◽  
Anatomical Difference ◽  
Upper Thoracic

Background: Sympathetic blocks (SBs) have been used widely to relieve the symptoms of sympathetically maintained pain (SMP). The thoracic sympathetic ganglion is not separated from somatic nerves by muscles and connective tissue. The upper thoracic ganglion runs along the posterior surface of the vertebral column in close proximity to the adjacent epidural region. This anatomical difference leads to frequent epidural and intercostal spread in cases of thoracic SBs. The purpose of this study was to investigate the incidence of inadvertent intercostal and epidural injections during thoracic SBs.Methods: Twenty-two patients who were suffering from complex regional pain syndrome or lymphedema after breast cancer surgery were managed with two or three times of thoracic SBs. Therefore, injections of 63 thoracic SBs from 22 patients were enrolled in this study. An investigator who did not attend the procedure evaluated the occurrence of intercostal or epidural spread using anteroposterior fluoroscopic images.Results: The overall incidence of inadvertent intercostal or epidural spread of contrast was 47.5%. Among the inadvertent injections, intercostal spread (34.9%) was more frequent than epidural spread (12.6%). Only 52.5% of the thoracic SBs demonstrated successful contrast spread without any inadvertent spread. The mean difference in skin temperature between the blocked and unblocked sides was 2.5 ± 1.8ºC. Fifty-nine (93.6%) injections demonstrated more than 1.5ºC difference.Conclusions: Thoracic SBs showed a high incidence (47.5%) of inadvertent epidural or intercostal injection. Thus, special attention is required for the diagnosis of SMP or the injection of any neurolytic agent around sympathetic ganglion.

scholarly journals Botulinum Toxin Type A for Lumbar Sympathetic Ganglion Block in Complex Regional Pain Syndrome: A Randomized Trial

2021 ◽  
Author(s):  
Yongjae Yoo ◽  
Chang-Soon Lee ◽  
Jungsoo Kim ◽  
Dongwon Jo ◽  
Jee Youn Moon
Keyword(s):  
Botulinum Toxin ◽  
Complex Regional Pain Syndrome ◽  
Sympathetic Ganglion ◽  
Botulinum Toxin Type A ◽  
Pain Syndrome ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Control Group ◽  
Ganglion Block ◽  
Relative Temperature

Background The present study was designed to test the hypothesis that botulinum toxin would prolong the duration of a lumbar sympathetic block measured through a sustained increase in skin temperature. The authors performed a randomized, double-blind, controlled trial to investigate the clinical outcome of botulinum toxin type A for lumbar sympathetic ganglion block in patients with complex regional pain syndrome. Methods Lumbar sympathetic ganglion block was conducted in patients with lower-extremity complex regional pain syndrome using 75 IU of botulinum toxin type A (botulinum toxin group) and local anesthetic (control group). The primary outcome was the change in the relative temperature difference on the blocked sole compared with the contralateral sole at 1 postoperative month. The secondary outcomes were the 3-month changes in relative temperature differences, as well as the pain intensity changes. Results A total of 48 participants (N = 24/group) were randomly assigned. The change in relative temperature increase was higher in the botulinum toxin group than in the control group (1.0°C ± 1.3 vs. 0.1°C ± 0.8, respectively; difference: 0.9°C [95% CI, 0.3 to 1.5]; P = 0.006), which was maintained at 3 months (1.1°C ± 0.8 vs. –0.2°C ± 1.2, respectively; P = 0.009). Moreover, pain intensity was greatly reduced in the botulinum toxin group compared with the control group at 1 month (–2.2 ± 1.0 vs. –1.0 ± 1.6, respectively; P = 0.003) and 3 months (–2.0 ± 1.0 vs. –0.6 ± 1.6, respectively; P = 0.003). There were no severe adverse events pertinent to botulinum toxin injection. Conclusions In patients with complex regional pain syndrome, lumbar sympathetic ganglion block using botulinum toxin type A increased the temperature of the affected foot for 3 months and also reduced the pain. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Continuous Thoracic Sympathetic Ganglion Block in Complex Regional Pain Syndrome Patients with Spinal Cord Stimulation Implantation

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
EungDon Kim ◽  
MiSun Roh ◽  
SooHyang Kim ◽  
DaeHyun Jo
Keyword(s):  
Spinal Cord ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Sympathetic Ganglion ◽  
Pain Syndrome ◽  
Term Effect ◽  
Sympathetic Block ◽  
Short Term ◽  
Ganglion Block ◽  
Ischemic Disease

The sympathetic block is widely used for treating neuropathic pain such as complex regional pain syndrome (CRPS). However, single sympathetic block often provides only short-term effect. Moreover, frequent procedures for sympathetic block may increase the risk of complications. The use of epidural route may be limited by concern of infection in case of previous implantation of the spinal cord stimulation (SCS). In contrast, a continuous sympathetic block can be administered without such concerns. The continuous thoracic sympathetic block (TSGB) has been used to treat the ischemic disease and other neuropathic conditions such as postherpetic neuralgia. We administered continuous thoracic sympathetic block using catheter in CRPS patients who underwent SCS implantations and achieved desirable outcomes. We believe a continuous sympathetic block is a considerable option before performing neurolysis or radiofrequency rhizotomy and even after SCS implantation.

scholarly journals Ultrasound Guided Stellate Ganglion Block in Postmastectomy Pain Syndrome: A Comparison of Ketamine versus Morphine as Adjuvant to Bupivacaine

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Ola T. Abdel Dayem ◽  
Mostafa M. Saeid ◽  
Olfat M. Ismail ◽  
Adel M. El Badrawy ◽  
Nevert A. Abdel Ghaffar
Keyword(s):  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
Pain Syndrome ◽  
Visual Analogue Score ◽  
Breast Cancer Surgery ◽  
Ultrasound Guided ◽  
Ganglion Block ◽  
Morphine Group ◽  
Analgesic Drugs ◽  
Group 2

Background. The postmastectomy pain syndrome (PMPS) is chronic pain after breast cancer surgery and is reported to influence quality of life. The aim of this study was to provide long term reduction of PMPS, improve range of motion of the shoulder, and decrease the need for postoperative analgesia using ultrasound guided stellate ganglion block. Method. Sixty patients with PMPS were randomly allocated into 1 of 3 groups: bupivacaine group (group 1), bupivacaine plus ketamine group (group 2), and bupivacaine plus morphine group (group 3). Each patient received 3 blocks with an interval of one week in between. Patients were assessed for: pain visual analogue score (VAS), movement of the shoulder, skin temperature, and the need for analgesic drugs. Results. The pain VAS was significantly decreased in group 2 as compared to the other two groups. Shoulder movement improved significantly in the three studied groups with the best results observed after the third block. The need for the analgesic drugs in the form of gabapentin was more in the bupivacaine and bupivacaine plus morphine groups than in bupivacaine plus ketamine group. Conclusion. Treatment of PMPS with ultrasound guided stellate ganglion block using ketamine (0.5 mg/kg) as adjuvant to bupivacaine (0.25%) successfully decreased pain VAS and the need for analgesic drugs.

scholarly journals Application of the sympathetic ganglion block to the spinal cord injured patients.

1990 ◽  
Vol 38 (3) ◽  
pp. 1111-1115
Author(s):  
Kesateru Koga ◽  
Hiroaki Koga ◽  
Yoshihiro Deguchi ◽  
Hiroshi Ogata ◽  
Juji Nishi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Sympathetic Ganglion ◽  
Ganglion Block ◽  
Injured Patients ◽  
Spinal Cord Injured

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

2010 ◽  
Vol 23 (1) ◽  
pp. 11 ◽  
Author(s):  
Won Ho Kim ◽  
Sang Kwon Kim ◽  
Chul Joong Lee ◽  
Tae Hyeong Kim ◽  
Woo Seok Sim
Keyword(s):  
Sympathetic Ganglion ◽  
Entry Angle ◽  
Ganglion Block
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