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PubMed1993

[Changes in the blood flow in celiac artery and superior mesenteric artery after stellate ganglion block].

We evaluated the effect of stellate ganglion block (SGB) on the blood flow of celiac artery (CA) and superior mesenteric artery (SMA) by using the ultrasonic pulse Doppler technique. The subjects were 15 healthy volunteers (14 males, one female; average 26 years old; 22-38). Right C7-SGB was performed using 5 ml of 1% mepivacaine at the 7th cervical process. Blood pressure, heart rate, mean blood flow velocity and diameter in CA and SMA, were measured after 5 minute rest, before and after SGB. To measure the flow velocity and the diameter of vessels, ultrasonic diagnostic equipment SSA-270A or SSA-260A (Thoshiba CO, Ltd.) with convex electric-phased 3.75 MHz, probe was used. Doppler shiftgrams of the CA and SMA were recorded. Then, we calculated their flow volume and sectional area of vessels. In CA mean blood flow velocity tended to decrease (P < 0.05) and both flow volume and sectional area of vessels tended to increase (P < 0.001). In SMA, mean flow velocity tended to decrease (P < 0.05) and sectional area increased (P < 0.001). But flow volume did not show significant change. Our results indicate that right C7-SGB leads to an increase in the blood flow of CA.

Adult↗
PubMed1993

An investigation into the extrinsic blood supply and the microvasculature of the rat stellate ganglion.

The extrinsic supply of the rat stellate ganglion (STG) has been investigated by histological examination of the vasculature following india ink injections by a variety of routes. The main arterial supply to the STG is derived from an un-named branch of the pericardiophrenic branch of the costocervical trunk of the subclavian artery but a small contribution is made to the rostral part of the STG from microvessels running in the cervical sympathetic trunk. Similarly there are microvessels running in the nerve trunks connected to the STG and these, together with those in the cervical sympathetic trunk, can perfuse the STG when the subclavian artery is occluded. The second and third intercostal arteries do not supply the STG. Measurements of alkaline phosphate-stained microvascular endothelial cells reveal that microvessel diameters (6.5 +/- 0.54 microns) in the rat STG are comparable to those in other rat sympathetic ganglia as is the endothelial surface area available for exchange to a given volume of blood. However the density of the microvascular bed in the STG is greater (553.2 mm/mm3) than in other rat sympathetic ganglia and individual neurones in the STG are surrounded by a higher number of microvessels within a radius of 25 microns from the centre of the nucleus. These results suggest that the metabolic demands of STG neurones may be higher than in other sympathetic ganglia.

Alkaline Phosphatase↗
PubMed1981

The relations of the superior pole of the stellate ganglion to the vertebral artery.

The relations of the superior pole of the stellate ganglion to the vertebral artery and to the transverse processes of the last cervical and the first thoracic vertebrae were studied in 440 specimens (220 adult human embalmed cadavers). The superior pole of the ganglion was found, most commonly, within an "arterial triangle" bordered by the subclavian, the common carotid and the vertebral arteries (75.8%), at the level of the inferior third of the vertebral artery (79.8%) and anterior to the interval between the transverse process of the seventh cervical and the first thoracic vertebrae (48.6%). The variations of these locations of the stellate ganglion, found in this study, may be of significant surgical anatomical importance.

Adult↗
PubMed1993

The effects of unilateral stellate ganglion blockade on human cardiac function during rest and exercise.

INTRODUCTION: Left-sided stellate ganglion predominance has been proposed as a mechanism responsible for lethal ventricular arrhythmias, due to heterogenous ventricular repolarization. To determine the cardiovascular effects of such asymmetric sympathetic ganglion innervation in man, studies were performed in 15 patients undergoing unilateral stellate ganglion blockade for the management of chronic arm pain. METHODS AND RESULTS: Standard 12-lead ECGs, systemic blood pressure, body surface potential mapping, and radionuclide angiography were performed during rest and graded exercise before and after blockade. Successful unilateral blockade was accomplished in 13 of the patients, 11 of whom had right-sided blockade and two left-sided blockade. No significant changes due to blockade of stellate ganglia, including QT intervals, were detected during rest or graded exercise in standard ECGs. No cardiac rhythm disturbances occurred in these states. Body surface potential maps and arterial blood pressure were similar during resting supine and upright positions, as well as immediately after exercise before and after blockade. Unilateral ganglionic blockade did not modify resting or exercise cardiac ejection fractions. CONCLUSION: Unilateral stellate blockade in man does not induce untoward cardiovascular effects during rest or exercise.

Adult↗
PubMed2001

[Stellate ganglion radiofrequency neurolysis under CT guidance. Preliminary study].

Sympathetically maintained pain syndrome of the upper limb is difficult to treat even with high doses of specific medication. Stellate ganglion block by in situ injection of a local anesthetic is an efficient and accepted method for diagnosis and treatment. The sedative effect is however transitory linked to the short effect of the drug. CT guidance, displaying an excellent contrast between soft tissues, bones, vessels and nerves, is a well suited and safe mean of guidance. Seven patients suffering from reflex sympathetic dystrophy were treated by stellate ganglion radiofrequency (RF) neurolysis at two sites (C7 and T1). Patients were evaluated for pain before and immediately after the procedure and at three months. Four patients had a significant (50%) pain relief lasting at 3 month. One patient had a temporary pain (one week) and 2 no pain relief. No patient had a Horner syndrome. One patient had a temporary neuralgia of surrounding nerves (brachial plexus). RF neurolysis of stellate ganglion under CT-guidance is precise and appears efficient but further investigation on a larger cohort of patients is needed.

Adult↗
PubMed2004

[Preganglionic inputs to cat stellate ganglion in postnatal ontogenesis].

Localization of the spinal cord preganglionic neurons projecting to the stellate ganglion, was studied in kittens from the moment of birth till six month of life, using the method based on retrograde axonal transport of horseradish peroxidase. The number of preganglionic neurons and spinal cord segments connected with the stellate ganglion, increased from the moment of birth till 10th postnatal day, decreasing afterwards. The proportion of preganglionic neurons in different nuclei of the spinal cord changed during the development and became comparable to that in adult animals by 6th month. The proportion of neurons in the nucleus intermediolateralis thoracolumbalis pars principalis was found to increase, while the number of neurons in the nucleus intermediolateralis thoracolumbalis pars funicularis and in the spinal cord ventral horns was decreased.

Aging↗
PubMed1997

Lidocaine tape relieves pain due to needle insertion during stellate ganglion block.

PURPOSE: To investigate the efficacy of lidocaine tape, a new preparation of lidocaine for cutaneous topical anaesthesia in the form of a self-adhesive tape, in alleviating the pain of needle insertion during stellate ganglion block. METHODS: In a double-blind, placebo controlled study, 30 adult outpatients undergoing stellate ganglion block were allocated to receive all of the following five treatments in random order: placebo tape applied to the intended site of the block (control), or lidocaine tape applied for 7, 15, 30, and 60 min. After the block was performed using a 24-gauge needle, the pain associated with needle insertion was assessed using a visual analogue scale (10 cm VAS) and the four-point verbal rating score (VRS 0-3). RESULTS: With placebo tape, the VAS and VRS scores were 2.4 +/- 1.27 (0.5-4.8) (mean +/- SD (range)) and 1.5 (1-2) (mean (range)), respectively. The pain scores were reduced (P < 0.01) by lidocaine tape after application for 7 min (1.6 +/- 1.06 and 1.0 (0-2) for VAS (mean +/- SD) and VRS (mean (range)), respectively), 15 min (1.5 +/- 1.00 and 1.0 (1-2)), 30 min (1.5 +/- 1.08 and 1.0 (1)), and 60 min (0.6 +/- 0.70 and 0.6 (0-1)). Skin erythema was more frequent with lidocaine tape than with placebo tape (seven minutes of lidocaine tape vs placebo tape, P < 0.05; 15, 30, and 60 min of lidocaine tape vs placebo, P < 0.0005). CONCLUSION: Stellate ganglion block without analgesia is fairly painful in some patients, even when using a 24-gauge needle, and needle pain is reduced by lidocaine tape after an application time of seven minutes or more.

Adult↗
PubMedDate not supplied

The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand.

BACKGROUND AND OBJECTIVES: Although an increase in skin temperature of the hand implies sympathetic block after stellate ganglion block (SGB), it does not indicate complete sympathetic block unless accompanied by an absence of sweating because skin temperature may increase even with a partial sympathetic block. This study examined the efficacy of the SGB to block sweating in the hand and to determine if the magnitude of temperature change in the hand is predictive of a negative sweat test. METHODS: Fifty-nine SGBs were performed in 30 patients (15 women and 15 men) for diagnostic or therapeutic indications. Stellate ganglion block was performed via an anterior paratracheal approach at C6 using 15 mL 0.25% bupivacaine. Skin temperature was measured bilaterally on the index finger. A cobalt blue sweat test was performed bilaterally pre- and post-SGB on the middle finger. Successful sympathetic block after SGB was considered present when: (a) (change in ipsilateral temperature (postblock-preblock)] (Di)-[change in contralateral temperature] (Dc) > or = 1.5 degrees C; (b) Horner's syndrome present; and (c) sweat test changed from positive to negative. Logistical regression was applied to determine what value of Di - Dc could be used to predict a negative sweat test. RESULTS: Thirty-six percent (21/59) of blocks met all three criteria. Of the blocks where Di - Dc > or = 1.5 degrees C, 72% (21/29) had a negative sweat test post-SGB. Of the blocks where Di - Dc < 1.5 degrees C, 37% (11/30) had a negative sweat test postblock. If Di - Dc > or = 2.0 degrees C, a negative sweat test could be predicted with 69 +/- 12% sensitivity and 85 +/- 10% specificity. CONCLUSIONS: Stellate ganglion block often fails to increase skin temperature in the ipsilateral more than the contralateral hand. A value of Di - Dc > or = 2.0 degrees C was a good predictor of a sympathetic block, but was not sufficient to guarantee a complete sympathetic block of the hand after SGB in all cases. An apparently successful SGB as measured by "usual" clinical criteria may not result in a complete sympathectomy of the hand as is often assumed. Therefore, if obtaining a sympathectomy is important for diagnostic or therapeutic purposes, performing a sweat test provides important confirmatory evidence of the genuine success of the sympathetic block.

Adolescent↗
PubMed2006

Effect of linear polarized light irradiation near the stellate ganglion in skin blood flow of fingers in patients with progressive systemic sclerosis.

OBJECTIVE: The purpose of this study is to evaluate the effect of linear polarized light irradiation near the stellate ganglion area on cutaneous blood flow in fingers of patients with progressive systemic sclerosis. BACKGROUND DATA: Sympathetic overactivity is known to be present in patients with progressive systemic sclerosis. Recently introduced linear polarized light irradiation is designed to simulate noninvasive stellate ganglion block to decrease sympathetic output. METHODS: Five patients with progressive systemic sclerosis and three normal healthy controls were studied. Linear polarized light (Super Lizer) was irradiated near the stellate ganglion on the right side of the neck at 358 J/cm(2) for 10 min. Then, laser Doppler flowmetry, laser Doppler imager, and capillary microscopy were used to measure the cutaneous blood flow of the right fourth finger for 30 min. RESULTS: No significant alternations of the skin blood flow between normal controls and patients with progressive systemic sclerosis after linear polarized light irradiation were detected. The effect of linear polarized light on the microcirculation of patients with progressive systemic sclerosis was minimal and transient. CONCLUSION: The effect of linear polarized light in treating patients with progressive systemic sclerosis may not result from the improvement of skin blood flow. Therefore, the use of linear polarized light in those patients to increase cutaneous blood flow should not be overemphasized.

Adult↗
PubMed1976

An unusual complication after stellate ganglion block by the paratracheal approach: a case report.

A case is presented of repeated stellate ganglion block using the paratracheal approach at the level of C6 and using the low dose method. Subarachnoid spread of local anaesthetic resulted in total spinal block below the level of C4. The potential hazards of this techinque of stellate ganglion block and methods of avoiding them are discussed, together with the possible mechanism in this case.

Autonomic Nerve Block↗
PubMed1975

[Stellate ganglion block under EEG control in the treatment of complicated cervical migraine (author's transl)].

Complicated migraine is regarded as a cerebrovascular syndrome of functional character. In the case of a young man with cervical migraine associated with paroxysmal neurological disorders and persisting EEG abnormalities, stellate ganglion blocks were performed under EEG control. A transient amelioration of the pathological EEG pattern was observed after each stellate ganglion block and after several treatments the EEG was normal and the migraine attacks disappeared. The pathophysiology of the effect of stellate ganglion block on cerebral blood flow is discussed.

Adult↗
PubMed1991

[The effect of drug therapy and stellate ganglion block with or without oxygen inhalation on sudden hearing loss].

Forty-one patients suffering from sudden hearing loss were studied by the following method. Twenty patients (group A) were treated with oral administration of prednisolone, intravenous administration of vitamin B and C, furosemide and stellate ganglion block. Another 21 patients (group B) were treated with oral administration of these drugs, stellate ganglion block and oxygen inhalation. Forty six percent of all these patients, 35 percent of group A and 57 percent of group B, regained less than 20 dB of their normal hearing level. The patients who are younger, having shorter duration from first finding of symptoms to starting of therapy and smaller average deficiency of hearing, without dizziness are easy to recover. Oxygen inhalation with drug therapy and stellate ganglion block is a useful treatment for sudden hearing loss.

Adolescent↗
PubMedDate not supplied

Use of stellate ganglion block to salvage an ischemic hand caused by the extravasation of vasopressors.

OBJECTIVE: This case report describes the successful use of early stellate ganglion block to salvage an acutely ischemic hand caused by the extravasation of vasopressors. CASE REPORT: A young man with a gunshot wound to the right inguinal area was brought to the operating room for surgical hemostasis and exploration. After discovery that the central line had been inserted in the proximity of the area of injury (right femoral vein), the vasopressor infusions were changed to a 14-gauge intravenous line inserted in the dorsum of the right hand. When the intravenous line became infiltrated, the hand was found to be swollen, cold, and underperfused. A right stellate ganglion block was immediately performed to overcome the intense peripheral vasoconstriction and, thus, re-establish circulation to the hand. CONCLUSIONS: Stellate ganglion block may prove to be an early measure in the treatment of upper-extremity ischemia caused by vasopressor extravasation.

Adult↗
PubMed2005

Anterior cervical approach for stellate ganglion and T2 to T3 sympathetic blocks: a novel technique.

BACKGROUND: Stellate ganglion block is used for the diagnosis and treatment of sympathetically maintained pain syndromes. Multiple anatomic variations and inaccurate sympathetic block may mislead the diagnosis and prevent patients from receiving potentially beneficial interventions. We describe a novel approach to blockade of the sympathetic chain at C7 and at T2 to T3 with a single-needle injection. TECHNIQUE: With the patient in supine position, the uncinate process of C7 is identified fluoroscopically as a target for insertion of a catheter through a Touhy needle. The catheter is directed caudally to the junction of T2 and T3. Contrast injection confirms the spread to the appropriate levels before injection of local anesthetic. CONCLUSION: This novel approach to blockade of the upper extremity sympathetic innervation may enhance diagnostic accuracy and therapeutic benefit as compared with traditional approaches to the stellate ganglion alone. This approach may be expected to decrease the risk of pneumothorax when compared with the posterior approach to T2 to T3.

Journal Article↗
PubMed2003

Effects of linearly polarized 0.6-1.6 microM irradiation on stellate ganglion function in normal subjects and people with complex regional pain (CRPS I).

BACKGROUND AND OBJECTIVES: Stellate ganglion blocks are an effective but invasive treatment of upper extremity pain. Linearly polarized red and near-infrared (IR) light is promoted as a safe alternative to this procedure, but its effects are poorly established. This study was designed to assess the physiological effects of this latter approach and to quantitate its benefits in people with upper extremity pain due to Complex Regional Pain Syndrome I (CRPS I, RSD). STUDY DESIGN/MATERIALS AND METHODS: This was a two-part study. In the first phase, six adults (ages 18-60) with normal neurological examinations underwent transcutaneous irradiation of their right stellate ganglion with linearly polarized 0.6-1.6 microm light (0.92 W, 88.3 J). Phase two consisted of a double-blinded evaluation of active and placebo radiation in 12 subjects (ages 18-72) of which 6 had upper extremity CRPS I and 6 served as "normal" controls. Skin temperature, heart rate (HR), sudomotor function, and vasomotor tone were monitored before, during, and for 30 minutes following irradiation. Analgesic and sensory effects were assessed over the same period as well as 1 and 2 weeks later. RESULTS: Three of six subjects with CRPS I and no control subjects experienced a sensation of warmth following active irradiation (P = 0.025). Two of the CRPS I subjects reported a >50% pain reduction. However, four noted minimal or no change and improvement did not reach statistical significance for the group as a whole. No statistically significant changes in autonomic function were noted. There were no adverse consequences. CONCLUSIONS: Irradiation is well tolerated. There is a suggestion in this small study that treatment is beneficial and that its benefits are not dependent on changes in sympathetic tone. Further evaluation is warranted.

Adolescent↗
PubMed1959

The function of the proximal synapses of the squid stellate ganglion.

In the oxygenated excised squid (Loligo pealii) stellate ganglion preparation one can produce excitation of the stellar giant axons by stimulating the second largest (accessory fiber, Young, 1939) or other smaller preganglionic giant axons. Impulse transmission is believed to occur at the proximal synapses of the stellar giant axons rather than the distal (giant) synapses which are excited by the largest giant preaxon. Proximal synaptic transmission is more readily depressed by hypoxia and can be fatigued independently of, and with fewer impulses than, the giant synapses. Intracellular recording from the last stellar axon at its inflection in the ganglion reveals both proximal and distal excitatory postsynaptic potentials EPSP's). The synaptic delay, temporal form of the EPSP, and depolarization for spike initiation were similar for both synapses. If the proximal EPSP occurs shortly after excitation by the giant synapse it reduces the undershoot and adds to the falling phase of the spike. If it occurs later it can produce a second spike. Parallel results were obtained when the proximal EPSP's arrived earlier than the EPSP of the giant synapse. In fatigued preparations it was possible to sum distal and proximal or two proximal EPSP's and achieve spike excitation.

Animals↗
PubMed2006

[Rhythmical electrical activity in the cat stellate ganglion during postnatal ontogenesis].

Electrical activity of the stellate ganglion was studied in newborn, 10-, 20-, 30-day-old, two- and six-month-old kittens using the spectral analysis. The development of sympathetic activity patterns was different during ontogenesis. The amplitude of discharges increased from the period of birth until the second month of kittens' life. In newborn and 10-day-old kittens, synchronous discharges of postganglionic fibers were represented by slow and low frequency impulses with frequencies of breathing and heart rate. ppears in 20-day-old kittens. The formation of the sympathetic discharge patterns ends at the second month of animals life.

Action Potentials↗
PubMed1991

Dynamics of neurotensin stores in the stellate ganglion of the cat.

Neurotensin (NT) within the stellate ganglion (SG) of the cat is present in axon terminals of extrinsic, presumably preganglionic, neurons and may play a role in ganglionic transmission. NT content of the SG, and of the preganglionic axons which innervate it, was determined by radioimmunoassay in the anesthetized cat under various experimental conditions in order to understand the factors determining the size of the ganglionic NT stores. The immunoreactive NT (iNT) from extracts of SG and its preganglionic inputs (white rami T2 and T3, sympathetic trunk between SG and T4 white ramus) coeluted with synthetic NT(1-13) on RP-HPLC. NT accumulated proximal to ligatures on the preganglionic inputs of the SG. The daily rate of axonal transport of NT, estimated from the accumulation, represents 28.7% of the ganglionic stores of NT. Preganglionic stimulation at 2 Hz for 100 min did not change ganglionic NT content. Preganglionic stimulation at 40 Hz reduced the NT content to 70.4 +/- 1.8% of control in 10 min and to 34.7 +/- 4.2% of control in 20 min. Additional 100 min of 40 Hz stimulation produced no further depletion. The residual iNT, which coeluted with NT1-13, presumably represents a pool of unreleasable NT. Post-depletion recovery was complete in 7 days and showed an initial rapid phase over the first 24 h followed by a slower phase over the remaining 6 days. Pepsin treatment, which has previously been shown to generate iNT from NT precursor in liver and other tissues, provided no evidence of the NT precursor in extracts of SG and its preganglionic input.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗