Yeungnam Univ J Med.  2018 Dec;35(2):199-204. 10.12701/yujm.2018.35.2.199.

Comparison of ultrasound-guided stellate ganglion block at 6th and 7th cervical vertebrae using the lateral paracarotid out-of-plane approach for sympathetic blockade in the upper extremity

• Baek J
• Kim BS
• Yu H
• Kim H
• Lim C
• Song SO

• KMID: 2433739
• DOI: http://doi.org/10.12701/yujm.2018.35.2.199

Abstract

BACKGROUND
The authors have performed ultrasound-guided stellate ganglion block (SGB) in our clinic using a lateral paracarotid approach at the level of the 6th cervical vertebra (C6). Although SGB at C6 is a convenient and safe method, there are ongoing concerns about the weak effect of sympathetic blockade in the ipsilateral upper extremity. Therefore, ultrasound-guided SGB was attempted using a lateral paracarotid approach at the level of the 7th cervical vertebra (C7). This prospective study aimed to compare changes in skin temperature after SGB was performed at C6 and C7, and to introduce a lateral paracarotid approach for SGB.
METHODS
Thirty patients underwent SGB twice: once at C6 and once at C7. For every SGB, the skin temperature of the patient's hypothenar area was measured for 15 min at 1-min intervals. Skin temperatures before and after SGB and side effects were compared between C6 and C7 groups.
RESULTS
The temperature of the upper extremity increased after SGB was performed at C6 and C7. There were significant differences between mean pre-SGB and the largest increases in post-SGB temperatures (0.50±0.38℃ and 1.41±0.68℃ at C6 and C7, respectively; p < 0.05). Significantly increased post-SGB temperatures (difference >1℃) were found in 5/30 (16.7%) and 24/30 (80%) cases for C6 and C7, respectively (p < 0.05). There were no significant differences in side effects between SGB performed at C6 or C7 (p>0.05).
CONCLUSION
The lateral paracarotid approach using out-of-plane needle insertion for ultrasound-guided SGB performed at C7 was feasible and more effective at elevating skin temperature in the upper extremity than SGB at C6.

Keyword

Skin temperature; Stellate ganglion; Sympathetic nerve block; Ultrasonography; Upper extremity

MeSH Terms

Autonomic Nerve Block
Cervical Vertebrae*
Female
Humans
Methods
Needles
Prospective Studies
Skin Temperature
Spine
Stellate Ganglion*
Ultrasonography
Upper Extremity*

Figure

• 

  Fig. 1. The spread of local anesthetics at C6 level. Arrows show the subfacial spread of local anesthetics above the longus colli muscle. CA, carotid artery; LCo, longus colli muscle; SCM, sternocleidomastoid muscle; Thy, thyroid gland; T, Chassaignac’s tubercle; med, medial; lat, lateral.

• 

  Fig. 2. In the C7 transverse view, the vertebral artery come out from the tubercle and is seen easily. Arrows show the subfascial spread of local anesthetics above the longus colli muscle. CA, carotid artery; LCo, longus colli muscle; SCM, sternocleidomastoid muscle; Thy, thyroid gland; VA, vertebral artery; med, medial; lat, lateral.

Reference

1. Narouze S, Vydyanathan A, Patel N. Ultrasound-guided stellate ganglion block successfully prevented esophageal puncture. Pain Physician. 2007; 10:747–52.

2. Narouze S. Ultrasound-guided stellate ganglion block: safety and efficacy. Curr Pain Headache Rep. 2014; 18:424.

3. Kim H, Song SO, Jung G. A lateral paracarotid approach for ultrasound-guided stellate ganglion block with a linear probe. J Anesth. 2017; 31:458–62.

4. Jung G, Kim BS, Shin KB, Park KB, Kim SY, Song SO. The optimal volume of 0.2% ropivacaine required for an ultrasound-guided stellate ganglion block. Korean J Anesthesiol. 2011; 60:179–84.

5. Moore DC. Therapeutic stellate ganglion block: 5 versus 10 mL of a local anesthetic. Reg Anesth Pain Med. 2008; 33:191–2.

6. Song SO, Jo YW. Effects of the volume of local anesthetic used in stellate ganglion block on the elevation of skin temperature of ipsilateral upper extremity. Korean J Anesthesiol. 1999; 37:233–9. Korean.

7. Elias M. Cervical sympathetic and stellate ganglion blocks. Pain Physician. 2000; 3:294–304.

8. Hogan QH, Erickson SJ. MR imaging of the stellate ganglion: normal appearance. AJR Am J Roentgenol. 1992; 158:655–9.

9. Hogan QH, Erickson SJ, Haddox JD, Abram SE. The spread of solutions during stellate ganglion block. Reg Anesth. 1992; 17:78–83.

10. Hogan QH, Erickson SJ, Abram SE. Computerized tomography-guided stellate ganglion blockade. Anesthesiology. 1992; 77596–9.

11. Smith DW. Stellate ganglion block; the tissue displacement method. Am J Surg. 1951; 82:344–8.

12. Moore DC, Bridenbaugh LD Jr. The anterior approach to the stellate ganglion use without a serious complication in two thousand blocks. J Am Med Assoc. 1956; 160:158–62.

13. Higa K, Hirata K, Hirota K, Nitahara K, Shono S. Retropharyngeal hematoma after stellate ganglion block: Analysis of 27 patients reported in the literature. Anesthesiology. 2006; 105:1238–45.

14. Moore DC. An unusual complication after stellate ganglion block. Br J Anaesth. 1964; 36:601.

15. Uchida T, Nakao S, Morimoto M, Iwamoto T. Serious cervical hematoma after stellate ganglion block. J Anesth. 2015; 29:321.

16. Hong JT, Park DK, Lee MJ, Kim SW, An HS. Anatomical variations of the vertebral artery segment in the lower cervical spine: analysis by three-dimensional computed tomography angiography. Spine (Phila Pa 1976). 2008; 33:2422–6.

17. Kapral S, Krafft P, Gosch M, Fleischmann D, Weinstabl C. Ultrasound imaging for stellate ganglion block: direct visualization of puncture site and local anesthetic spread. A pilot study. Reg Anesth. 1995; 20:323–8.

18. Lee MH, Kim KY, Song JH, Jung HJ, Lim HK, Lee DI, et al. Minimal volume of local anesthetic required for an ultrasound-guided SGB. Pain Med. 2012; 13:1381–8.

19. Bhatia A, Flamer D, Peng PW. Evaluation of sonoanatomy relevant to performing stellate ganglion blocks using anterior and lateral simulated approaches: an observational study. Can J Anaesth. 2012; 59:1040–7.