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PubMed1989

Extent of sympathetic blockade after stellate ganglion block with bupivacaine.

A study of the extent of sympathetic blockade after stellate ganglion block was assessed using liquid crystal thermography. Two volumes (10 and 20 ml) of bupivacaine 0.5% plain were used. Irrespective of the volume used cranial sympathetic block always occurred and thoracic sympathetic block never occurred. While upper cervical block was present in all patients, lower cervical sympathetic block was present only in the 20-ml group (P less than 0.05). The larger volume was associated with a significant incidence of hoarseness due to spread of local anaesthetic onto adjacent laryngeal nerves.

Brain↗
PubMed1993

[Efficacy of stellate ganglion block judged by quantitative measurement of perspiration].

Sudomotor function tests provide information on the activation of the sympathetic efferent fibers. We have studied the efficacy of stellate ganglion block (SGB) by assessment of changes in perspiration of the thumb in 10 patients. SGB was performed at C7 with 6 ml of 1% mepivacaine, and perspiration was induced by mentally stressful conversation and having patients draw up their knees for physical stress. Suzuken Kenz Perspiro OSS-100 was used for quantitative detection of perspiration. The value before SGB was 1.49 +/- 0.46 mg.3 min-1, and it showed a statistically significant decrease to 0.73 +/- 0.33 mg.3 min-1 10 min after SBG (P < 0.01). The present study suggests that quantitative measurement of perspiration is useful to judge the effects of SGB on arm.

Adult↗
PubMed1995

Transneuronal labeling of CNS neuropeptide and monoamine neurons after pseudorabies virus injections into the stellate ganglion.

The viral transneuronal labeling method was used in combination with immunohistochemical procedures to identify CNS neuropeptide and monoamine neurons that innervate the sympathetic preganglionic neurons (SPNs) which project to the stellate ganglion--the principal source of the sympathetic supply to the heart. Transneuronal labeling was found at three CNS levels: spinal cord, brainstem, and hypothalamus. In the thoracic spinal cord, apart from the pseudorabies virus (PRV)-labeled stellate SPNs, PRV-labeled neurons were localized in laminae I/II, IV, V, VII, and X as well as in the lateral spinal nucleus and lateral funiculus. In the C1-C4 spinal segments, labeled neurons were found in the lateral funiculus as well as laminae V and VII of the spinal gray matter. PRV-labeled cells were identified in lamina V and the dorsolateral funiculus of the lumbar spinal cord. Three medullary areas were consistently labeled: rostral ventromedial medulla (RVMM), rostral ventrolateral medulla (RVLM), and caudal raphe nuclei. The greatest concentration of labeling was found in the RVMM. This projection arose from adrenergic, serotonergic (5-HT), thyrotropin releasing hormone (TRH), substance P, somatostatin, enkephalin, and vasoactive intestinal peptide (VIP) immunoreactive neurons. The RVLM projection originated mainly from C1 adrenergic neurons, some of which contained immunoreactive neuropeptide Y (NPY). C3 adrenergic-NPY neurons lying near the floor of the 4th ventricle were also labeled. Enkephalin-, somatostatin- and VIP-immunoreactive RVLM neurons also contributed to this projection. 5-HT neurons of the caudal raphe nuclei (raphe pallidus, raphe obscurus, and raphe magnus) were labeled; some of these contained substance P or TRH-immunoreactivity with an occasional neuron staining for all three putative neurotransmitters. In the pons, catecholamine neurons in the A5 cell group, subcoeruleus and Kolliker-Fuse nuclei were labeled. The midbrain contained relatively few infected cells, but some were present in the Edinger-Westphal and precommissural nuclei. Forebrain labeling was concentrated in the paraventricular hypothalamic nucleus (PVN) with lesser amounts in the lateral hypothalamic area (LHA) and the perifornical region. In the PVN, oxytocin-immunoreactive neurons accounted for the greatest chemically-defined projection while corticotrophin releasing factor (CRF), vasopressin-, and angiotensin II-immunoreactive neurons provided successively lesser inputs. In the LHA, angiotensin II-immunoreactive neurons were labeled. In summary, this study provides the first detailed map of the chemically-coded CNS neurons involved in the control of the cardiosympathetic outflow.

Animals↗
PubMed1991

[Thermographic assessments of the sympathetic blockade by stellate ganglion block (2)--Comparison and analysis of thermographic patterns between C7-SGB and C6-SGB in 20 healthy volunteers].

We studied effects of two methods of stellate ganglion block (SGB) by evaluating the extent and strength of sympathetic blockade using infrared thermography, and classifying thermographic hot areas in the ipsilateral hand after SGB. Twenty healthy volunteers (18 females, 2 males, age 29.7 +/- 7.7 years) were subjects for this study. C7 and C6-SGBs were performed on each subject using 5 ml of 1% plain mepivacaine at the anterior face of 7th cervical transverse process in C7-SGB or at the top of the anterior tubercle of 6th cervical transverse process in C6-SGB. Thermography was performed before and 30 minutes after SGB. On the thenar and the hypothenar as well as the second, and the fourth finger tips, changes of skin temperature in the C7-SGB group were significantly larger than those in the C6-SGB group (P less than 0.05). There were no significant differences on the forehead or the cheek between the two groups. Thermographic hot areas on the ipsilateral hand after SGB were classified into three patterns as follows; whole hot area, partial hot area and absent hot area. Frequency of whole hot area pattern in the C7-SGB group (65%) was significantly higher than the one (30%) in the C6-SGB group (P less than 0.05). Frequency of absent hot area pattern in the C7-SGB group (5%) was significantly lower than the one (35%) in the C6-SGB group (P less than 0.05). All subjects showed Horner's sign. No severe side-effect occurred in either group, but complaints of dysphagia appeared significantly more frequently in the C6-SGB group than in C7-SGB (P less than 0.05). In conclusion, C7-SGB was considered to be superior to C6-SGB in strength and certainty of the lower cervical and upper thoracic sympathetic blockade, with less of side-effects.

Adult↗
PubMed1995

[A case of RSD with complete disappearance of symptoms following intravenous ketamine infusion combined with stellate ganglion block and continuous epidural block].

A 74 year-old woman with a 6-month history of RSD following herpes zoster on her right arm was treated with stellate ganglion blocks (SGB), continuous epidural block (CEB) and continuous intravenous infusion of ketamine known as one of the NMDA receptor blockers. Of the symptoms of RSD, burning pain and hyperperspiration but allodynia disappeared after the treatment with SGB 8 times and CEB for 4 days. Allodynia disappeared completely after ketamine treatment, where ketamine was infused once using a subanesthetic dose for 2 hours. It is considered that ketamine is one of the useful drugs for the treatment of neuropathic pain with allodynia.

Aged↗
PubMed1992

[The effect of stellate ganglion block therapy on tonsillitis].

We examined a 35-year-old male patient with recurrent tonsillitis who did not respond to operation and drug therapy and we treated him by stellate ganglion block (SGB) alone. The clinical symptoms improved by the SGB. There was no subsequent recurrence. The result suggests that SGB therapy is effective for recurrent tonsillitis.

Adult↗
PubMedDate not supplied

Assessment of QT interval and QT dispersion following stellate ganglion block using computerized measurements.

BACKGROUND AND OBJECTIVES: Prolongation of QT interval and QT dispersion (QTD) may be associated with an increased risk of arrhythmias. This study was designed to investigate the effects of right or left stellate ganglion block (SGB) on RR interval, QT interval, the rate-corrected QT (QTc) interval, QTD and the rate-corrected QTD (QTcD) using computerized measurements. METHODS: Ten healthy volunteers underwent both right and left SGBs using 7 mL 1% mepivacaine with a 7-day interval between the 2 blocks. The measurement from the 12-lead electrocardiogram was performed for 60 minutes after SGB. RESULTS: Right SGB induced a significant decrease of RR interval immediately after the block, and significant increases of QT interval, QTc interval, QTD, and QTcD from immediately through 50 minutes after the block (P <.01). Left SGB induced a significant decrease of RR interval, and significant increases of QTc interval and QTD immediately after the block (P <.01). Left SGB also produced a significant decrease of QT interval from 20 through 50 minutes after the block, and a significant decrease of QTc interval from 30 through 50 minutes after the block (P <.05). CONCLUSIONS: Right SGB induces increases of the QT interval, QTc interval, QTD, and QTcD, and left SGB induces decreases of the QT interval and QTc interval.

Adult↗
PubMed1980

Absence of stellate ganglion influence on alveolar-duct constriction.

Previous work has shown decreased lung compliance with high wash fluid surface tensions, but normal ratios of lung weight to body weight during stellate ganglion stimulation (SGS) in cats and monkeys. In the present study, effects of SGS on diameters of alveolar ducts were determined in spontaneously breathing cats under ketamine anesthesia. Compliance and pulmonary resistance were also measured. A fluorocarbon cooled to - 100 degrees C was poured onto an exposed lung lobe after rapidly opening the chest after sham operation and during SGS. Examination of the outer 2 mm of the lungs by light microscopy revealed no alveolar-duct constriction by SGS, although compliance decreased by 15%. Pulmonary resistance was unchanged. Alveolar-duct diameters were 157 +/- 4.3 micron (mean +/- SEM) in control animals and 163 +/- 4.6 micron in SGS cats. Absence of alveolar-duct constriction suggests that peripheral airway constriction did not contribute to the decrease in compliance during SGS.

Airway Resistance↗
PubMed1994

Properties of putative cardiac and non-cardiac neurones in the rat stellate ganglion.

Intracellular recordings were made from isolated left or right stellate ganglia of Wistar rats and the morphology of neurones studied after intracellular injection of hexammine cobaltic chloride or back-filling from the post-ganglionic nerve with cobalt lysine complex. The experiments attempted to identify the location, electrophysiological properties, morphology and chemosensitivity of putative cardiac neurones in the ganglion. These were identified by antidromic activation of the axon in a cardiac nerve and compared with neurones projecting towards the brachial plexus (non-cardiac neurones). Putative cardiac neurones were localized in the ganglion around the postganglionic nerve entry zone and showed considerable morphological diversity. They had complex dendritic trees with, on average, seven dendrites. They included both phasic and tonic neurones and were depolarized by muscarinic agonists, angiotensin and substance P; they invariably had a synaptic input from the sympathetic trunk and from a T1 or T2 ramus and, in 16% of cells, from a cardiac nerve. Non-cardiac neurones were more widely scattered through the stellate ganglion but were not clearly different in morphology, resting membrane potential or the proportion of phasic and tonic cells from putative cardiac neurones. They also showed depolarizing responses to muscarinic agonists, angiotensin and substance P. Angiotensin responses of stellate ganglion cells were blocked by the peptide antagonist, saralasin (1 microM).

Action Potentials↗
PubMed2000

Stellate ganglion block modifies the distribution of lymphocyte subsets and natural-killer cell activity.

BACKGROUND: Recent investigations suggest that the sympathetic nervous system affects the immune system. This study examined whether stellate ganglion block (SGB) affects the immune response, specifically the distribution of lymphocyte subsets and natural-killer (NK) cell activity. METHODS: Ten volunteers received three different treatments in random order at 7-day intervals: (1) SGB with 7 ml of 1% lidocaine; (2) an identical volume of normal saline injected at the same site as SGB; and (3) an identical volume of 1% lidocaine injected intramuscularly. Blood samples were drawn before and 30 min after treatment. The distribution of lymphocyte subsets was analyzed, and NK cell activity was measured. Plasma concentrations of epinephrine, norepinephrine, adrenocorticotropic hormone, and cortisol were measured. RESULTS: Any value in the normal saline and intramuscular treatments did not change significantly. After SGB, the plasma concentrations of epinephrine and norepinephrine decreased significantly (P < 0.01), but adrenocorticotropic hormone and cortisol values were unchanged. Increases were observed in the proportion of B cells (from 18.4 +/- 3.0% to 20.0 +/- 3.8%; P < 0.01) and T cells (from 64.2 +/- 4.1% to 67.1 +/- 4.2%; P < 0.01). A decrease in the proportion of NK cells was observed (from 13.4 +/- 2.7% to 9.8 +/- 2.2%; P < 0.01). The proportion of CD4+ cells increased (P < 0.01), and that of CD8+ cells decreased (P < 0.01), so that the CD4+ cell/CD8+ cell ratio increased (P < 0.01). The proportion of CD29+ (helper-inducer T) cells increased (P < 0.05), but that of CD45RA+ (suppressor-inducer T) cells did not change. NK cell activity decreased significantly (from 33.6 +/- 8.3% to 29.1 +/- 7.6%; P < 0.01). CONCLUSIONS: A small but significant alteration in lymphocyte subsets and in NK cell activity by SGB indicates that local sympathetic nerve block may modulate the immune response.

Adult↗
PubMed2001

Development of the evoked potentials in the thalamus and cerebral cortex after stimulation of the stellate ganglion afferents in kittens.

The primary evoked potentials (EP) were studied in newborn, 10-, 20-day-old, 1-month-old kittens in the thalamus and cerebral cortex after stimulation of the stellate ganglion (SG) afferents. The nerves were irritated with single square-wave pulses with an amplitude of 1.2-1.3 threshold for EP appearance. In all kittens, EP were registered in the same zones as in adult animals. In the thalamus, this zone was represented by the centromedial part of the ventralis posterior lateralis (n. VPL), contralaterally to the stimulation place. In the cerebral cortex, the EP were observed in the cerebral cortex, specifically in the somatosensory zones S1 and S2 also contralaterally to the stimulation place. In postnatal ontogenesis, the latency of evoked potentials decreases, amplitude increases and the form of these potentials transforms from negative in newborn kittens to positive-negative wave in 1-month-old animals. Maturation of the SG afferent pathways exists in parallel with the somatosensory ones and does not finish at 1 month of life.

Afferent Pathways↗
PubMedDate not supplied

Sufentanil stellate ganglion injection in the treatment of refractory reflex sympathetic dystrophy.

Reflex sympathetic dystrophy is a neurologic disorder with characteristic symptomatology including burning dysesthesia, swelling, and vasomotor alteration. Two patients with refractory reflex sympathetic dystrophy underwent stellate ganglion injection with 10 mcg of sufentanil in 10 ml preservative-free saline. Both reported decrease in pain and improved mobility, which was long lasting.

Adult↗
PubMedDate not supplied

Effects of head-up tilt after stellate ganglion block on QT interval and QT dispersion.

BACKGROUND AND OBJECTIVES: The aim of this study is to examine the effects of head-up tilt (70 degrees ) 30 minutes after right or left stellate ganglion block (SGB) on RR interval, QT interval, the rate-corrected QT (QTc) interval, QT dispersion (QTD), and the rate-corrected QT dispersion (QTcD) using computerized measurement. METHODS: Ten healthy volunteers underwent both right and left SGBs using 7 mL 1% mepivacaine with a 7-day interval between the two blocks. A 12-lead electrocardiogram was monitored to measure parameters before SGB; 30 minutes after SGB (before head-up tilt); and immediately, 5, 10, and 15 minutes after head-up tilt. RESULTS: Right SGB induced significant increases in QT interval, QTc interval, QTD, and QTcD from 30 minutes after the block through 15 minutes after head-up tilt. There were significant increases of QT interval, QTc interval, and QTcD between before and immediately after head-up tilt in right SGB. Left SGB induced significant decreases of QT interval and QTc interval from 30 minutes after SGB through 15 minutes after head-up tilt. Left SGB also induced a significant decrease of QTD from immediately after through 10 minutes after head-up tilt. CONCLUSIONS: Significant increases of QT interval, QTc interval, and QTcD, which are associated with an increased risk of ventricular arrhythmias and cardiac events, occur immediately after head-up tilt in right SGB. However, head-up tilt does not induce increases of QT interval, QTc interval, QTD, and QTcD in left SGB.

Adult↗
PubMed2001

Sympathetic neurons of the cat stellate ganglion in postnatal ontogenesis: morphometric analysis.

Basic morphometric parameters (the maximal diameter, cross-sectional area), the distribution density of neurons were determined in the zones of the emergence of the basic nerves and in the center of the stellate ganglion (SG) in newborn, 10-, 20-day-old as well as 1- and 2-month-old kittens. Most of the investigated neurons in all animals were oval in their profile. In parallel to the increase of the average diameters, the number of small neurons decreased and the percentage of large neurons increased in postnatal ontogenesis. In all kittens, neurons with larger average size were located in the cranial pole of the ganglion. In 10-day-old kittens and older animals, the average size of neurons was more in the left SG in comparison to the right one. Only in 1-month-old kittens the density of location of neurons in the right ganglion exceeded such parameters of neurons located at the left side. The number of neurons in the SG was not constant in postnatal ontogenesis and reduced from newborn to 20-day-old animals.

Animals↗