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PubMedDate not supplied

Phantom pain with probable reflex sympathetic dystrophy: efficacy of fentanyl infiltration of the stellate ganglion.

BACKGROUND AND OBJECTIVES: The stellate ganglion can alleviate phantom pain of the upper extremity, possibly because of the presence in it of enkephalin receptors, as has been suggested by experimental and clinical reports. A case is reported in which fentanyl, instead of local anesthetic, was used for stellate ganglion block. METHODS: A 49-year-old man, with a left below-elbow amputation, presented with probable symptoms of reflex sympathetic dystrophy, pain and temperature changes at the stump, and phantom hand symptoms the English-language literature revealed no reports of the use of fentanyl infiltration of the stellate ganglion was performed for management of this condition. RESULTS: Significant alleviation of pain and sensation of warmth at the stump and in the phantom hand was achieved. CONCLUSIONS: Fentanyl infiltration of the stellate ganglion proved to be successful in the management of the pain and temperature sensation changes in the stump and phantom upper extremity.

Analgesics, Opioid↗
PubMed1992

MR imaging of the stellate ganglion: normal appearance.

The stellate ganglion has not previously been identified by imaging techniques. MR imaging shows the stellate ganglion at the thoracic inlet adjacent to the neck of the first rib, lateral to the longus colli muscle and posterior to the vertebral artery. Although its shape varies somewhat, it can be identified consistently in normal persons.

Adult↗
PubMedDate not supplied

Circuits and projections of cat stellate ganglion.

BACKGROUND: Although connections of stellate ganglion (SG) have been widely explored, some features of pathways and projections remain unknown, such as the source and fate of preganglionic axons present in output branches, including both synaptically interrupted and traversing pathways as well as axon composition (efferent and afferent) of these output nerves. METHODS: Circuits and central projections of cat SG were investigated using horseradish peroxidase (HRP) tracer and electrophysiologic techniques including stimulation of ganglionic branches during recording of genesis of compound action potentials in other nerves or centrally evoked responses. RESULTS: All branches of SG including vertebral nerve are mixed, i.e., they contain axons that synapse in the periphery or traverse ganglia. A novel synaptically interrupted pathway bi-directionally coursing along subclavian branches and inferior cardiac nerve was identified. Preganglionic axons traversing stellate ganglion course in communicating branch to vagus nerve and to inferior cardiac nerve, a small number of these preganglionic axons traversing stellate ganglion reach cervical sympathetic trunk via subclavian branches. For the first time, a small number of preganglionic traversing pathways were also detected in vertebral nerve. Afferent axons with somata located in C8-T7 dorsal root ganglia, identified in all branches of SG, projected centrally to neurons in thalamus and somatosensory zones of cerebral cortex and coincided with afferent projections of brachial plexus. CONCLUSIONS: Present data contribute to the morphologic description of autonomic regulation of thoracic organs, including centrally independent peripheral autonomic axon reflexes.

Animals↗
PubMed1994

Left stellate ganglion block impairs left ventricular function.

Stellate ganglion block (SGB) is an established procedure for the diagnosis and treatment of chronic pain. SGB results in an acute sympathetic denervation of a part of the left ventricular (LV) wall innervated by the blocked ganglion, which may impair regional contractility. The resulting imbalance of myocardial contractility in different LV regions may affect LV function adversely by increasing LV asynchrony. Seven anesthetized open chest dogs were instrumented for measurement of aortic and LV pressure (tip manometers), cardiac output (CO, thermodilution), and regional LV wall thickness (WT, sonomicrometry) in the anteroapical (predominantly innervated by the right stellate ganglion) and posterobasal wall (left stellate ganglion). The contractility of both regions was assessed using the relationship between preload recruitable stroke work and end-diastolic WT relationship (MW). The timing of regional myocardial wall motion was evaluated by means of the phase of the first harmonic of the Fourier transform of the WT signals, LV asynchrony by the phase difference (PD) between both regions, and LV diastolic function by the time constant of isovolumic relaxation (tau). Measurements were performed before and after left SGB (LSGB). Mean arterial pressure was 105 +/- 25 (mean +/- SD) before and 97 +/- 10 mm Hg after LSGB (not significant). CO remained unchanged (3.09 +/- 1.03 vs 2.93 +/- 1.07 L/min). LSGB significantly reduced contractility in the posterobasal myocardium (MW -162 +/- 26 vs -80 +/- 7 mm Hg; P < 0.01), accompanied by a delay of regional wall motion within the cardiac cycle (phase 202 +/- 18 vs 223 +/- 17 degrees; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Contralateral spread of local anesthetic with stellate ganglion block.

BACKGROUND AND OBJECTIVES. Stellate ganglion block is a technically simple procedure but is liable to many complications because of the adjacent structures. We report a contralateral and bilateral Horner's syndrome with stellate ganglion block in the same patient on different occasions. We also report a bilateral recurrent laryngeal nerve block with this procedure.

Adult↗
PubMed1996

Stellate ganglion block is associated with increased tibial nerve muscle sympathetic activity in humans.

BACKGROUND: Left stellate ganglion block has been shown to increase heart rate and blood pressure, possible because of blockage of afferent vagal fibers from arterial baroreceptors in the aortic arch. Because efferent muscle sympathetic nerve activity (MSNA) is influenced by the arterial baroreflex, the hypothesis that left stellate ganglion block increases efferent MSNA recorded from the tibial nerve of humans was tested. METHODS: Twenty healthy male volunteers were sequentially assigned to one of three groups: stellate ganglion block (n = 10), in which 7 ml 1% mepivacaine was injected into the left stellate ganglion; placebo (n = 5), in which 7 ml of saline was injected into the left stellate ganglion; and intramuscular injection (n = 5), in which 7 ml mepivacaine was injected into the left deltoid muscle. Direct intraneural microneurographic recording with a tungsten microelectrode was used to record MSNA in the left tibial nerve. MSNA, heart rate, and blood pressure were recorded before and after injection in all groups. An additional five volunteers were studied with transthoracic echocardiography to examine the effect of stellate ganglion block on preload changes. RESULTS: Tibial nerve MSNA increased after mepivacaine injection to the left stellate ganglion but was unchanged after saline injection to the left stellate ganglion or mepivacaine injection into the deltoid muscle. Heart rate increased significantly after the left stellate ganglion block but did not change significantly after saline injection to the left stellate ganglion or after mepivacaine injection to the deltoid muscle. Systemic blood pressure did not change significantly in all groups. Left ventricular end-diastolic area and left ventricular end-diastolic circumference did not change after stellate ganglion block. CONCLUSIONS: Tibial nerve MSNA increased during left stellate ganglion block with mepivacaine.

Adult↗
PubMed2005

A novel technique for experimental stellate ganglion block in rats.

UNLABELLED: A stellate ganglion block (SGB) is routinely performed in a clinical setting for the treatment of sympathetically maintained pain syndromes. However, the cardiovascular effects of SGB have not been well defined. The purpose of the present study was to develop a new technique of SGB in a rat model. Our new technique of SGB is a posterior percutaneous approach and uses the cartilaginous process of the C7 spinous process as a landmark. Twenty-six Sprague-Dawley female rats were divided into six groups. Group I (n = 4) underwent right sided SGB, Group II (n = 5) underwent left-sided SGB, and Group III (n = 5) underwent bilateral SGB using bupivacaine 0.25%. Three additional sham groups (n = 4 in each group) served as controls to each of the three treatment groups. Ipsilateral eyelid droop (ptosis) was observed in all animals that underwent SGB with bupivacaine. Heart rate decreased significantly for up to 45 min after bilateral SGB compared with control groups. However, this value did not change in rats after unilateral SGB. In 9 additional rats, we evaluated the accuracy of SGB by injecting methylene blue to stain the right (n = 3), left (n = 3), and bilateral SGB (n = 3). At autopsy, 11 of 12 SG were stained post-methylene blue injection. We conclude from our study that our new approach, posterior percutaneous SGB is a reliable technique that can be used for further studies. IMPLICATIONS: We describe a new technique for stellate ganglion block in rats that may be used in future studies to investigate the role of cervical sympathetic nervous system (especially the stellate ganglion) in regulating sympathetically maintained pain and myocardial function.

Anesthesia, General↗
PubMed1999

Effects of unilateral stellate ganglion block on the spectral characteristics of heart rate variability.

The effect of unilateral stellate ganglion block on cardiovascular regulation remains controversial, so the present study used power spectral analysis of heart rate variability to investigate its effect on the autonomic neural control of the heart. In 20 young healthy volunteers (mean age: 25 years), heart rate variability was determined before and after unilateral stellate ganglion block (right side 11, left side 9) using 8 ml of 1% mepivacaine during supine rest. Using autoregressive spectrum analysis, power spectra were quantified by measuring the area in 3 frequency bands: high-frequency power (lnHF, parasympathetic influence) from 0.15 to 0.40 Hz, low-frequency power (lnLF, predominantly sympathetic influence) from 0.04 to 0.15 Hz, and total-frequency power (lnTF) less than 0.40 Hz. Right stellate ganglion block decreased not only the lnLF component from 6.55+/-0.84 to 5.77+/-0.47 but also the lnHF component from 4.40+/-0.95 to 3.42+/-1.12 (p<0.05). In contrast, left stellate ganglion block changed neither the lnLF nor the lnHF component. The lnTF component was also decreased significantly by right stellate ganglion block from 7.80+/-0.95 to 7.01+/-0.36 (p<0.05), but was unchanged following left stellate ganglion block. Neither right nor left stellate ganglion block induced any significant change in both the RR and corrected QT intervals. However, changes in the RR interval induced by right stellate ganglion block showed significant positive correlation with changes in lnHF (p<0.005) and lnTF (p<0.05). These results suggest that (1) autonomic innervation to the sinus node is mainly through the right-sided stellate ganglion, (2) pharmacological right-sided stellate ganglion block may attenuate not only sympathetic but also parasympathetic activity and (3) following right stellate ganglion block the decrease in both the sympathetic and parasympathetic influence on the sinus node may inconsistently counterbalance and change the RR interval.

Adult↗
PubMed1979

Preeminence of the left stellate ganglion in the long Q-T syndrome.

In seven patients with Romano-Ward syndrome, stellate ganglion block or stimulation and pharmacologic interventions were made to assess their influence on duration of the O-T interval, electrical alteration of the T wave and ventricular tachydysrhythmias. Left stellate ganglion block and right stellate ganglion stimulation shortened Q-T interval, abolished alternans phenomena and suppressed tachydysrhythmias. Propranolol and phenytoin had a similar effect. In contrast, right stellate ganglion block, left stellate ganglion stimulation and prior administration of quinidine and procainamide had an opposite effect. These responses resemble observations in animal models which suggest that excessive or unopposed activity of the left, or subnormal activity of the right stellate ganglion, or both, account for the pathophysiologic manifestations of the long Q-T syndrome. They are also consistent with clinically correlated, cardiac neuropathologic findings in these patients. An analogous but acquired dysautonomia involving the left stellate ganglion and ischemic left ventricle may precipitate sudden coronary death.

Adult↗
PubMed2000

Cervical sympathetic and stellate ganglion blocks.

Sympathetic blocks in the cervical and upper thoracic region are commonly used techniques for a variety of diagnostic, therapeutic and prognostic purposes. Stellate ganglion block is the common nomenclature utilized, however, stellate ganglion is present in only 80% of the population, thus, either lower cervical sympathetic block or upper thoracic sympathetic block is an appropriate term. The cervical sympathetic ganglia are identified as the superior, middle, intermediate and the inferior cervical sympathetic ganglion. The superior cervical ganglia are approximately 3 to 5 cm in length and situated on the longus capitus muscle anterior to the transverse process of the second, third, and rarely the fourth cervical vertebrae; the middle cervical ganglia are the smallest of the cervical ganglia situated on the longus colli muscle, anterior to the base of the transverse process of the sixth vertebrae; and the intermediate cervical ganglia which are more consistent in position and are located on the medial side of the vertebral artery. The inferior cervical ganglia, when present, are located on the transverse process of the C7 vertebrae, whereas the first thoracic ganglia are situated in front of the neck of the first rib. In 70% to 80% of the population they are fused together forming the stellate ganglion. Stellate ganglion block or lower cervical sympathetic block has been advocated for both diagnostic, therapeutic, and prognostic purposes for a variety of conditions. Even though multiple techniques are advocated in performing this block, fluoroscopically guided sympathetic blocks are more appropriate. Complications of stellate ganglion block include complications related to the technique, infection, and pharmacological complications related to the drugs utilized. Cervical sympathetic or stellate ganglion block is a very commonly performed procedure. If performed correctly, this can provide good therapeutic, prognostic, and diagnostic values.

Journal Article↗
PubMed2005

[Immunocytochemical characteristic of neurons of the mouse truncus sympaticus stellate ganglion in postnatal ontogenesis].

Neurotransmitter content in stellate ganglion neurons was studied immunocytochemically in mice of different ages (newborns, 10-, 20-, 30- and 60-days-old). Majority of the stellate ganglion neurons in mice of all the groups studied were tyrosine hydroxylase (TH)-positive. Most of neurons with the immunore-activity to choline acetyltransferase (ChAT) were shown to be also TH-positive in the newborn and 10-day-old animals. The percentage of neurons containing TH and neuropeptide Y increased from birth throughout all the age periods studied. The proportion of vasoactive intestinal peptide (VIP)- and ChAT-positive neurons was maximal in 10-day-old animals and then decreased up to 60 days of age. The somatostatin- and galanin-reactive cells were absent in all the mice. Thus, the maturation of neurotransmitter composition is complete in the mouse stellate ganglion by the end of the second month of life.

Animals↗
PubMed1979

Changes of ventricular monophasic action potential duration by stellate ganglion stimulation in dogs.

Left or right stellate ganglion stimulation resulted in changes of ST segments and T waves of electrocardiogram. The present experiments were performed in an attempt to elucidate alpha-and beta-adrenergic actions, and calcium action on the monophasic action potential duration (APD), that is, the repolarizing phase of myocardium. During experiments in open-chest dogs, right ventricular pacing was performed for avoiding the acceleration of heart rate by stellate ganglion stimulation. Administration of phentolamine, propranolol or D600 prolonged APD, while hydrazine shortened it. However, stellate ganglion stimulation caused a prolongation of APD after infusion of propranolol or hydrazine, and a shortening of APD after infusion of phentolamine, D600 or hydrazine. These results indicate that alpha-and beta-adrenergic actions as well as calcium ions can be related to APD in the ventricular myocardium of dogs; apparently, alpha-adrenergic action prolongs APD and beta-adrenergic action shortens it.

Action Potentials↗
PubMed1996

[A case of severe hypertension caused by stellate ganglion block in a patient with facial palsy].

We report a case of severe hypertension following stellate ganglion block. A 61-year old woman received the left stellate ganglion block with 5 ml of 1% mepivacaine for her left facial palsy. Before the stellate ganglion block, blood pressure was 120/68 mmHg and heart rate was 62 b.p.m. Seven minutes after the left stellate ganglion block, blood pressure increased to 230/140 mmHg, but heart rate was unchanged. Systolic blood pressure remained above 190 mmHg for 60 minutes following the stellate ganglion block. We suggest that the extreme increase in blood pressure was due to the vagal nerve block associated with the left stellate ganglion block.

Anesthetics, Local↗
PubMed1986

Activity of in situ stellate ganglion neurons of dogs recorded extracellularly.

Activity was recorded from 145 neurons in the in situ stellate ganglia of 36 dogs. The activity of 28 of these neurons, most of them located in the ganglia's cranial medial region, was related to the cardiac cycle primarily during systole. The activity of 16 of these cardiovascular-related neurons was modified by gentle mechanical distortion of the superior vena cava (1), heart (4), or thoracic aorta (11). Forty-one of the neurons were modified by respiration, with 17 being phase-locked to the respiratory cycle. Other neurons were activated by gentle mechanical distortion of localized regions of the thoracic wall (21% of all neurons), neck (18%), skin of the left foreleg (10%), or the mediastinum adjacent to the stellate ganglion (3%). Acutely decentralizing the stellate ganglion abolished the spontaneous activity of some, but not all, of these neurons including the respiratory or cardiovascular-related neurons. In the intact or acutely decentralized stellate ganglion, few neurons were activated by single short duration (1-4 ms) stimuli delivered to nerves attached directly or indirectly to the ganglion; however, most were activated by brief high frequency stimuli delivered in trains of 20-200 ms, or by single stimuli lasting 20-200 ms. As most cardiovascular, respiratory, or neck-related neurons in the stellate ganglion were not activated by single brief stimuli delivered to the cardiopulmonary nerves or vagosympathetic trunks, presumably they did not project their axons into the neck or thoracic organs. Thus, they were considered to be interneurons. It is postulated that interneurons in stellate ganglia can be modified by afferent receptors located in tissues of the neck, lungs, heart, or great thoracic vessels, whether the ganglion is intact or acutely decentralized. In addition, neurons in the stellate ganglion can be modified by mechanoreceptors located in the thoracic wall, abdominal wall, foreleg, or adjacent mediastinum. The majority of these neurons are activated by trains of impulses rather than single short duration impulses.

Action Potentials↗
PubMed2000

Differential effects of right versus left stellate ganglion block on left ventricular function in humans: an echocardiographic analysis.

STUDY OBJECTIVES: To evaluate the effects of unilateral stellate ganglion blockade on left ventricular function. DESIGN: Prospective cohort of patients with chronic regional pain syndrome type I and II of the upper extremity requiring therapeutic stellate ganglion blockade. SETTING: University-affiliated hospital. PATIENTS: Fifteen adult ASA physical status I and II patients with the diagnosis of chronic regional pain syndrome type I and II of the arm were studied. Right stellate ganglion block was performed in nine subjects and a left in six. INTERVENTIONS: Stellate ganglion block was performed with 10 mL of 1% plain Xylocaine. Transthoracic echocardiograms were performed immediately prior and 30 min following the block. MEASUREMENTS: Heart rate and blood pressure were monitored at regular intervals. Global systolic function was determined by calculating ejection fraction. Regional systolic motion was evaluated on the short axis and four-chamber views using the American Society of Echocardiography criteria. Diastolic function was assessed with pulsed-wave Doppler of the left ventricular outflow tract and the mitral valve. Data collected included isovolumic relaxation time and early and atrial velocity patterns. MAIN RESULTS: A successful stellate ganglion block was achieved in all patients. Blood pressure and heart rate were not significantly different during data collection. Patients who underwent a right stellate ganglion block showed no significant differences in systolic or diastolic function. Following a left stellate ganglion block, global and regional systolic function remained unchanged. Isovolumic relaxation time was increased but did not reach statistical significance (80 +/- 13 ms to 88 +/- 9 ms; p = 0.09). Left ventricular end-diastolic (LVEDV) and end-systolic volumes (LVESV) were significantly increased (LVEDV from 73 +/- 9 mL to 100 +/- 9 mL, p < 0.02; LVESV from 31 +/- 4 mL to 37 +/- 4 mL, p < 0.03). CONCLUSIONS: In patients without cardiovascular disease, unilateral denervation of the left ventricle after stellate ganglion block produces no clinical deleterious effects on left ventricular function.

Adult↗
PubMed1992

[Polarized light irradiation near the stellate ganglion in a patient with Raynaud's sign].

Polarized light irradiation near the stellate ganglion was performed in a 55-year-old female with Raynaud's sign. She was suffering from cold and numb pain in bilateral fingers for 1 year. Stellate ganglion block and low reactive-level laser therapy near the stellate ganglion were not sufficient to relieve this symptom. Polarized light irradiation near the stellate ganglion induced a sting stimulation and warm sensation in her hands. Thermograms revealed a remarkable increase in temperature of her hands. The results imply that polarized light irradiation near the stellate ganglion increases blood flow of forearms and relieves Raynaud's sign.

Female↗
PubMed2001

[Effects of low reactive level laser, linear polarized light and Xenon-ray irradiation on the stellate ganglion in dogs].

The aim of this study was to clarify the influence of low reactive level laser, linear polarized light and Xenon-ray irradiation on stellate ganglion activity in dogs. Under general anesthesia, the right stellate ganglion was exposed by thoracotomy. After stabilization of the hemodynamic parameters, the following baseline measurements were taken: mean arterial pressure (MAP), heart rate (HR), and right brachial artery blood flow (BABF). Experiment 1: The stellate ganglion was directly irradiated for 10 min with low reactive level laser, linear polarized light or Xenon-ray. The hemodynamic parameters were measured for 60 min after each irradiation. Immediately after the irradiation study, stellate ganglion blockade (SGB) with 0.5% mepivacaine 1.0 ml was performed. Experiment 2: After confirming a decrease in BABF by direct electrical stimulation on the stellate ganglion, the stellate ganglion was directly irradiated with low reactive level laser, linear polarized light or Xenon-ray. The hemodynamic parameters were measured for 60 min after each irradiation. Immediately after the irradiation study with 0.5% mepivacaine 1.0 ml was performed. The hemodynamic parameters were also measured for 60 min after SGB. The changes in variables were not statistically significant after each irradiation in the experiment 1 and 2. After SGB, a significant decrease in HR and a significant increase in BABF occurred in the experiment 1 and 2. In conclusion, this study demonstrated that irradiation with low reactive level laser, linear polarized light and Xenon-ray of the stellate ganglion did not induce sympathetic blockade in dogs.

Animals↗