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PubMed2004

[A case of pyogenic osteomyelitis of the cervical spine following stellate ganglion block].

A 56-year-old woman had been treated with stellate ganglion block (SGB) for pigmentation degeneration retinopathy over 6 years. She had no history of diabetes mellitus or immunodeficiency. She complained of high back pain but was afebrile. She was diagnosed as pyogenic osteomyelitis by the MRI findings and hematological examination. Antibiotics was administerd for 3 weeks and inflammatory signs disappeared. We should bear in mind that pyogenic osteomyelitis is very rare but one of the most serious complications with SGB.

Autonomic Nerve Block↗
PubMed1985

Effects of unilateral stellate ganglion stimulation and ablation on electrophysiologic changes induced by acute myocardial ischemia in dogs.

We recorded direct-current extracellular electrograms simultaneously from 60 left ventricular epicardial sites in 38 alpha-chloralose-anesthetized dogs during repeated, 5 min coronary arterial occlusions. In each dog recordings made during control occlusions were compared with those made in occlusions after, or during, the following interventions on the sympathetic nervous system: left stellate ganglion stimulation, left stellectomy, right stellectomy, and clamping the abdominal aorta with intact sympathetic nerves to induce a rise of blood pressure equal to that present during left stellate stimulation. Heart rate was kept constant. Measurements included determination of TQ segment potentials and times of local activation. After 2 min of ischemia, the degree of TQ segment depression was increased by left stellate ganglion stimulation and was decreased by both left stellectomy and clamping the aorta. Also, the area showing negative TQ potentials, indicating decreased resting membrane potentials, was enlarged by both left stellate stimulation and right stellectomy and reduced by left stellectomy. No differences were found in the results of experiments in which the left anterior descending coronary artery was occluded and those in which the circumflex branch was occluded. Left stellate stimulation significantly improved conduction within the ischemic zone. No evidence was found to suggest that the arrhythmogenic effects of left stellate stimulation and of right stellectomy, confirmed in the present study, resulted from an increased likelihood for reentry in the subepicardium of the ischemic zone.

Animals↗
PubMed1993

Morphine injected around the stellate ganglion does not modulate the sympathetic nervous system nor does it provide pain relief.

Six patients with a presumptive diagnosis of upper limb reflex sympathetic dystrophy and 1 patient with anaesthesia dolorosa had pain and sympathetic activity assessed before and after injection of bupivacaine and morphine around the stellate ganglion. Sympathetic modulation was assessed by measuring the effect of each injection on the inspiratory gasping response (IGR), a measure of central arousal, the sympathetic skin response (SSR), a measure of peripheral sudomotor activity and the plethsymographic wave (PW), a measure of peripheral vasomotor activity. There were 5 women and 2 men with a mean age of 49 years (range: 41-66 years). The duration of pain varied from 9 months to 7 years. Bupivacaine abolished the IGR and SSR and increased the amplitude of the PW in all patients without any demonstrable sensory or motor blockade in the treated limb, nor did it have any effect on the contralateral IGR or PW. Bupivacaine did provide short-term pain relief in 4 out of 7 patients. Morphine did not produce any demonstrable effect on the sympathetic nervous system nor did it provide pain relief for any patient. Thus these data do not support injection of morphine around the stellate ganglion as it neither modulated sympathetic activity nor provided pain relief.

Adult↗
PubMed1985

Electrophysiologic effects of unilateral right and left stellate ganglion block on the human heart.

To determine the electrophysiologic effects of stellate ganglion (SG) block on the human heart, the two SGs were anesthetized separately, with a 24-hour interval between the two procedures, in 13 patients with episodes of supraventricular tachycardia (six had Kent bundles). Left SG block caused: (1) a lengthening of the AH interval, measured at fixed atrial rates of 10 +/- 12 msec (p less than 0.01); (2) a marked depression of the VA conduction in six of the seven patients with measurable VA interval (in two patients it produced complete VA block); (3) a slowing of 20 to 40 msec of the cycle of an electrically induced reciprocating tachycardia; and (4) failure to modify the QT interval duration. In contrast, right SG block produced asymmetric or opposite changes and prolonged the QT interval (7.6 +/- 8.8 msec, p less than 0.05). Atrial and ventricular refractoriness was not significantly altered by SG block. Retrograde effective refractory period of the Kent bundle changed 20 to 60 msec after unilateral SG blockade. Thus, this study suggests that the human conduction system and the Kent bundles receive an appreciable sympathetic influence from the SG. Like experimental studies, we also found an asymmetric response to unilateral SG block and a dominance, in most of our patients, of the left SG. The influence on myocardial refractoriness was less apparent.

Adult↗
PubMed2005

Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography.

BACKGROUND: Stellate ganglion block (SGB) causes vasodilatation in the skin of the head and neck because of regional sympathetic block. Its effects on cerebral haemodynamics, in health or in disease, are not clear. We evaluated the effects of SGB on ipsilateral middle cerebral artery flow velocity (MCAFV), estimated cerebral perfusion pressure (eCPP), zero flow pressure (ZFP), carbon dioxide reactivity (CO2R) and cerebral autoregulation using transcranial Doppler ultrasonography (TCD). METHODS: Twenty male patients, with pre-existing brachial plexus injury, and undergoing SGB for the treatment of complex regional pain syndrome of the upper limb, were studied. For SGB, 10 ml of plain lidocaine 2% was used and the onset of block was confirmed by presence of ipsilateral Horner's syndrome. The MCAFV, eCPP, ZFP, CO2R, and cerebral autoregulation were assessed before and after SGB using established TCD methods. The changes in these variables were analysed using Wilcoxon's signed rank test. RESULTS: The block caused a significant decrease in MCAFV from median (inter-quartile range) value of 61 (53, 67) to 55 (46, 60) cm s(-1), a significant increase in eCPP from 59 (51, 67) to 70 (60, 78) mm Hg, and a significant decrease in ZFP from 32 (26, 39) to 25 (16, 30) mm Hg. There were no significant changes in CO2R or cerebral autoregulation. CONCLUSION: The increase in eCPP, decrease in ZFP, and no changes in CO2R or cerebral autoregulation suggest that the SGB decreases cerebral vascular tone without affecting the capacity of the vessels to autoregulate. These effects may be of therapeutic advantage in relieving cerebral vasospasm in certain clinical settings.

Adolescent↗
PubMedDate not supplied

Dysrhythmias controlled with stellate ganglion block in a child with diabetes and a variant of long QT syndrome.

BACKGROUND AND OBJECTIVES: A 9-year-old boy with a history of poorly controlled insulin-dependent diabetes mellitus was found at home unresponsive. QT prolongation was diagnosed on inspection of Holter monitoring performed immediately before episodes of ventricular fibrillation. METHODS: In spite of medical management with propranolol, esmolol, phenytoin, and diazepam, the patient continued to have episodes of QT prolongation followed by ventricular dysrhythmias that reverted to sinus rhythm only after cardiopulmonary resuscitation and cardioversion. RESULTS: A series of left stellate ganglion blocks with bupivacaine eradicated the dysrhythmias. The child was then referred to another institution for insertion of an automatic internal cardioverter defibrillator. CONCLUSIONS: This case report emphasizes the effectiveness of left stellate ganglion block with bupivacaine in a child with a variant of long QT syndrome.

Autonomic Nerve Block↗
PubMed1996

Migraine headache following stellate ganglion block for reflex sympathetic dystrophy.

The alteration of extracranial blood flow in conjunction with clinical signs of autonomic nervous system dysfunction have led to various explanations concerning the pathophysiology of migraine headache. Reflex sympathetic dystrophy, a painful disorder of the sympathetic nervous system, can be treated by blocking the sympathetic nerves located in the stellate ganglion, resulting in vasodilation, ptosis, miosis, and anhydrosis. In theory, these changes could trigger a migraine headache attack secondary to autonomic dysfunction reflecting an imbalance between sympathetic and parasympathetic nervous systems. This may be especially true in a patient with a previous history of meningitis that may have resulted in a disorder of cerebrovascular regulation. We report a 56-year-old man with no previous history of migraine who developed migraine with aura after a stellate ganglion block. These episodic headaches occurred with decreasing frequency and severity for over 6 months, with eventual complete resolution. This interesting phenomenon has not been reported in the English literature and may help to better understand the pathophysiology of migraine.

Humans↗
PubMed1991

Possible inadvertent subdural block following attempted stellate ganglion blockade.

A case is reported of suspected inadvertent subdural block following attempted stellate ganglion blockade for relief of cervicobrachial pain in a patient suffering from reflex sympathetic dystrophy. Possible complications due to neuraxial spread of local anaesthetics while performing a cervicothoracic ganglion blockade are considered.

Adult↗
PubMed1982

The long QT syndrome; effects of drugs and left stellate ganglion block.

Four patients, two with congenital QT prolongation (Romano-Ward syndrome) and two with acquired idiopathic QT prolongation not related to bradycardia, drug toxicity, electrolyte imbalance, or neurological disorder were investigated for the onset of recurrent palpitations and/or syncope. The effects on the measured QT interval of intravenously administered propranolol (QTp), an infusion of isoproterenol (QTi) and left stellate ganglion block (QTs) were assessed at identical atrial paced rates and during sinus rhythm, corrected for rate change (QTc). Propranolol shortened the QTc in all patients. The QTp shortened only in those with congenital QT prolongation. Isoproterenol lengthened the QTc in the three patients studied. However, the QTi lengthened in the congenital syndrome whereas it shortened in the acquired syndrome. The QTs was uninfluenced by left stellate ganglion block in all patients. It is suggested that the congenital and acquired forms can be differentiated by pharmacological interventions and that the efficacy of propranolol in the former may result from its ability not only to increase the threshold for ventricular fibrillation, but also its ability to shorten the QT interval.

Adult↗
PubMed2002

Pain relief by stellate ganglion block in a case with trigeminal neuralgia caused by a cerebellopontine angle tumor.

A 29-year-old woman with symptoms suggestive of trigeminal neuralgia is presented. Because of her age, an intracranial tumor was suspected, but images of a brain computerized tomography scan revealed nothing in particular. A magnetic resonance imaging was scheduled 2 weeks later. However, as the pain increased and occurred more frequently, the patient returned to the hospital 2 days later. After a stellate ganglion block with transient nausea and dizziness, the pain was noticeably relieved. Using magnetic resonance scanning, a tumor in the cerebellopontine angle was discovered, and at surgical resection was diagnosed as an epidermoid tumor. Stellate ganglion block may provide pain relief to some patients who are suspected to have symptomatic trigeminal neuralgia.

Adult↗
PubMed1999

Contribution of nitric oxide to the presynaptic inhibition by endothelin ETB receptor of the canine stellate ganglionic transmission.

We previously reported that endothelin (ET) 3 inhibited presynaptically the dog stellate ganglionic transmission. Here, we report the investigation of the possible involvement of nitric oxide pathway in the endothelin-induced inhibition of the ganglionic transmission. The amount of acetylcholine released by preganglionic stimulation for 10 min was concentration-dependently inhibited after exposure to ET-3 (10(-9)-10(-6) M) or IRL-1620, endothelin ET(B) receptor agonist (10(-8)-10(-5) M). The inhibition was antagonized by pretreatment with a nonselective endothelin receptors antagonist (bosentan) and an ET(B) receptor antagonist (BQ-788) or a neuronal nitric oxide synthase inhibitor, 3-bromo-7-nitroindazole, but was not inhibited by a selective ET(A) receptor antagonist, BQ-123. The reduction induced by ET-3 was also antagonized by treatment with a selective inhibitor of soluble guanylyl cyclase, 1H-[1,2, 4]oxadiazolo[4,3-a]quinoxalin-1-one. In addition, similar reductions were also mimicked by exposure to cGMP analog, 8-bromoguanosine-3, 5-cyclic monophosphate and nitric oxide donor, S-nitroso-N-acetylpenicillamine. Exposure to ET-3 or IRL-1620 for a 30-min period increased the levels of total nitric oxide (NO), nitrite plus nitrate NO(x) concentration in the incubation medium, with the increase in NO(x) also being antagonized by BQ-788 at the same concentration. The ET-3-induced increase in NO(x) was antagonized by treatment with the same concentration of 3-bromo-7-nitroindazole or a selective inhibitor of receptor-mediated Ca(2+) entry, 1-[b-[3-(4-methoxyphenyl) propoxy]-4-methoxyphenethyl]-1H-imidazole (10(-5) M), and with a calmodulin antagonist, N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide. These results indicate that ET(B) receptor activation inhibits the sympathetic ganglionic transmission via reducing acetylcholine release from presynaptic nerve terminals, although this inhibition also seems to involve the ET(B) receptor-operated Ca(2+)-calmodulin-dependent activation of endogenous nitric oxide production.

8-Bromo Cyclic Adenosine Monophosphate↗
PubMed1976

Hemodynamic responses to stellate ganglion stimulation in mongrels and greyhounds.

A comparison of the effects of left stellate ganglion stimulation (SGS) on central and aortic hemodynamics has been made in chloralose-anesthetized mongrel (M), and greyhound (GH) dogs. Measurements of aortic pressure and flow, and left ventricular pressure were made during stimulation of the decentralized left SG at different frequencies from 0 to 20 Hz. The increases in aortic pressure and flow with SGS were larger in the GH, especially for low frequencies of stimulation. Stroke volume was increased with SGS in the GH at all stimulation rates, whereas in the M it was unchanged. A greater decrease in left ventricular end-diastolic pressure with SGS was found in the GH. These results suggest that differences exist in both the intrinsic and extrinsic control of cardiac output in the greyhound dog compared to the mongrel. These differences may be in part responsible for the elevated arterial blood pressure in the greyhound compared to the mongrel.

Adrenergic Fibers↗
PubMed1995

[Effects of stellate ganglion block on coronary circulation during acute coronary occlusion].

To evaluate effects of stellate ganglion block (SGB) on coronary circulation under coronary occlusion, the changes in cardiac function and tissue blood flow in the myocardial ischemic area after right and left SGB were observed in the dogs. Tissue blood flow in the myocardial ischemic area measured with laser doppler flowmeter showed no significant change after right or left SGB. In the right SGB group, heart rate, circumflex branch blood flow and rate pressure product decreased significantly (P < 0.01); end-diastolic pressure increased slightly (P < 0.05); myocardial oxygen extraction rate showed no significant change. On the other hand, in the left SGB group, heart rate, circumflex branch blood flow and rate pressure product showed no significant changes, while end-diastolic pressure and myocardial oxygen extraction rate increased significantly (P < 0.05). These data suggest that although right SGB might be useful to improve the oxygen demand-supply relation, left SGB does not improve the oxygen demand-supply relation and might increase the risk of myocardial ischemia.

Animals↗
PubMed2004

Effects of near-infrared irradiation to stellate ganglion in glossodynia.

OBJECTIVE: This study was designed to assess the effect of stellate ganglion near-infrared irradiation (SGR) on glossodynia and the mechanism of action. STUDY DESIGN: Thirty-seven patients with glossodynia received SGR once weekly for 4 weeks. The response to treatment was evaluated on the basis of the change in pain intensity, assessed with a visual analogue scale (VAS) before and after 4 weeks of treatment. The temperature and blood flow of the tongue were also measured before and after first SGR. As control, eight healthy subjects were studied. RESULTS: Tongue pain as assessed by the VAS decreased in 28 of the 37 patients (75.7%). Mean pain intensity decreased significantly from 5.1 +/- 2.2 to 1.9 +/- 2.1 (P < 0.05). Tongue blood flow at rest in the patients with glossodynia [7.2 +/- 1.6 ml min(-1) (100 g)(-1)] was significantly lower than that in the healthy subjects [7.8 +/- 0.23 ml min(-1) (100 g)(-1)]. Five minutes after SGR, the temperature of the tongue rose 1.5 +/- 0.21 degrees C, and blood flow increased to 8.5 +/- 1.2 ml min(-1) (100 g)(-1). Tongue blood flow (at rest) after 4 weeks of SGR had increased to 7.7 +/- 1.1 ml min(-1) (100 g)(-1). CONCLUSION: SGR is an effective treatment for glossodynia. The mechanism by which SGR improves symptoms associated with glossodynia is thought to be as follows: SGR inhibits abnormally increased sympathetic activity associated with glossodynia. This is followed by normalization of decreased tongue blood flow, thereby alleviating pain.

Aged↗
PubMed1982

Peripheral neural input to neurons of the stellate ganglion in dog.

In vitro and in vivo studies were conducted on the stellate ganglion (SG) of the dog by recording action potentials from its nerves and its neurons. For in vitro preparations, the SG and its nerve trunks were dissected from the animal and secured in an organ bath. Peripheral input to the SG was produced by electrical stimulation of the ventral ansa subclavia (VA), dorsal ansa subclavia (DA), and stellate cardiac nerve (SC) in 15 ganglion preparations studied in vitro. Electrical stimulation of the VA elicited action potentials recorded at the DA. This conducting pathway did not involve direct anatomic continuity, since the evoked potentials were blocked by injection of hexamethonium chloride into the SG. Most neurons in the SG received synaptic input from fibers of both central and peripheral origin. In 12 in vivo preparations, all nerves to the SG except the VA were cut. When peripheral sympathetic afferent input to the SG was increased, some of the postganglionic fibers of the dissected DA exhibited an increase in efferent nerve discharge. This response was also blocked by hexamethonium chloride. These results indicate that some of the functions of the SG might be independent of the central nervous system.

Action Potentials↗
PubMed1991

[Early stellate ganglion block failed to prevent progress of facial nerve palsy in a patient with Ramsay-Hunt syndrome--a case report].

A 73-year-old man complained of pain in his right ear with vesicular lesion for three days. He complained of no weakness of facial musculatures, but muscle test revealed slight weakness in orbital and oral muscles on admission. His hearing acuity of the left ear was intact. Vertigo with spontaneous nystagmus to left was complained. The patient was treated with stellate ganglion block four times a day, prednisolone 80 mg a day p.o. and acyclovir i.v. Mannitol solution 300 ml a day for eight days was given i.v. to reduce edema and to protect facial nerve. On his 3rd hospital day, his paralysis progressed and he could not close his eye or whistle with his mouth. Evoked myogram showed 91% impairment of the nerve. During recovery period there was discrepancy between facial palsy score of clinical signs and degree of nerve impairment by evoked myogram. On his 12th hospital day his facial nerve score improved 9 to 12 (0 complete paralysis, 40 no paralysis) but evoked myogram showed further progress of nerve impairment from 86% to 91% (Evoked wave heights were 14% and 9% of normal site respectively). The discrepancy is probably because facial palsy score reflects also neurapraxia of inflammatory nerve, and stellate ganglion block has no effect on changing course of facial nerve injury.

Aged↗
PubMed1967

Spontaneous synaptic potentials and quantal release of transmitter in the stellate ganglion of the squid.

1. Several kinds of synapses have been studied in the stellate ganglion of the squid.2. A small electric coupling was found between giant fibres in different stellar nerves.3. Post-synaptic potentials recorded from the cells of small axons are composite, indicating that there are converging inputs from several pre-ganglionic fibres.4. Spontaneous miniature synaptic potentials were recorded from all types of synapses. Miniature potentials in the cells of small axons had a slower time course than those in the giant fibre system.5. Tetrodotoxin abolished nerve impulses in the ganglion but did not prevent the spontaneous quantal release of transmitter from the terminals, or its action on the post-synaptic membrane; nor did it prevent the increase in rate of release produced by depolarization of the presynaptic fibre.6. Glutamate depolarized the giant fibre when applied iontophoretically to the synaptic region. Similar doses applied intracellularly were without effect.

Action Potentials↗