• The Korean Journal of Pain
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• v.23 no.4
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• pp.258-261
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• 2010

We report a 66-year-old woman with complex regional pain syndrome (CRPS) 1 treated with combined medical and active physical therapy. She was diagnosed with CRPS 1 following partial shoulder prosthesis due to proximal humerus fracture. Despite continuous medication and physical therapy, there was no improvement in her pain and functional outcome. Her overall pain was decreased by stellate ganglion block 3 times in two weeks conducted during the second month of the follow-up period. Following the ganglion blockades, pain and the other symptoms were decreased intermittently but range of motion (ROM) and functional status were not satisfied as much as expected. After the third month of follow-up, her passive and active ROM of the shoulder joint was increased after application of manipulation under general anesthesia. In conclusion, because CRPS 1 remains one of the most difficult pain syndromes, early diagnosis and treatment are important to have adequate functional results from physical therapy. Manipulation under general anesthesia may be an additional effective treatment tool to obtain functional improvement in some patients diagnosed with CRPS 1.

• The Korean Journal of Pain
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• v.13 no.2
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• pp.191-195
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• 2000

Background: Vascular occlusive event is one of the etiologies of sudden sensorineural hearing loss (SNHL). Stellate ganglion block (SGB) induces dramatic and intense vasodilatation in head and neck. Based on this principle, SGB has used as one of the treatment modalities in SNHL. This study was performed to evaluate immediate response of SGB on pure tone audiogram (PTA) in SNHL. Methods: Forty patients were studied. Each patient received daily ipsilateral SGB in paratracheal approach using 0.2% bupivacaine for 2 weeks. On first, third, and fifth day of treatment, we checked their PTA twice 1 hour before (Pre-PTA) and after (Post-PTA) SGB. Pre- and Post-PTA were compared. Several factors were analyzed as a prognostic factor of therapeutic results. Results: Eleven of 40 patients revealed decreased PTA after SGB. Degree of decreased PTA were insignificant ($2.5{\pm}1.6$ dB). Initial and final PTA results was $76.2{\pm}22.5$ and $49.8{\pm}28.3$ dB, respectively. Thirty-one of 40 patients were improved their PTA over 10 dB. The recovery was mainly influenced by the severity of initial hearing loss (P<0.001) and slightly by age (P<0.05). However, the change of PTA after SGB, time interval to receive SGB, sex, site, and number of SGB were not correlated to therapeutic outcome. Conclusions: These results suggest that vasodilatation by SGB has no immediate improvement in SNHL. Therefore, we question whether SGB is beneficial to all patients with SNHL as a therapeutic modality.

• The Korean Journal of Pain
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• v.13 no.2
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• pp.182-186
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• 2000

Background: Ropivacaine is a new amide local anesthetics, having therapeutic properties similar to those of bupivacaine but less cardiovascular toxicity and motor blockade. The aim of this study was to evaluate the effects of ropivacaine used in stellate ganglion block (SGB) compared with those of lidocaine or bupivacaine. Methods: This prospective and crossover study performed in twenty patients with sudden sensory neural hearing loss. All patients received three times SGB, in the paratracheal approach using 8 ml of 1% lidocaine, 0.2% bupivacaine, and 0.2% ropivacaine respectively without any orders. Onset time and action duration of Horner's syndrome were observed after each SGB. Results: Onset time of ropivacaine was the middle of the three agents; earlier lidocaine and slower bupivacaine. Lidocaine ($3.0{\pm}1.9$ min), bupivacaine ($4.1{\pm}2.9$ min) and ropivacaine ($3.3{\pm}1.3$ min). But there were no significant differences; Action duration of Horner's syndrome of ropivacaine (223.6?105.2 min) was longer than lidocaine ($134.6{\pm}77.3$ min) and shorter than bupivacaine ($241.2{\pm}115.8$ min). There were significant differences in the action duration of each local anesthetics (P<0.05). There was no critical side effects and temporary foreign body sensation was the most common side effect. Conclusions: We conclude that ropivacaine is a good alternative in SGB instead of lidocaine or bupivacaine. Ropivacaine is a long acting local anesthetic similar to those of bupivacaine with wide margin of safety. However, optimal concentration and volume of ropivacaine in SGB should be studied.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.68-71
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• 2006

Background: Stellate ganglion block (SGB) is a selective sympathetic blockade that affects the head, neck and the upper extremities. It is an important method that has been frequently used in pain clinics due to its wide range of indications. But there were some problem with performing SGB at C6 or C7. Thus, various techniques have been recently introduced to successfully perform SGB; among them, there is the oblique approach. This study was performed to evaluate the effectiveness of the oblique approach for performing SGB in C7. Methods: Forty six patients with sudden hearing loss were studied. In group I, the patient underwent C7 oblique SGB with 1% mepivacaine (3 ml) under fluoroscopic guidance. In group II, the patients underwent the C7 classical anterior approach SGB with 1% mepivaine (5 ml) under fluoroscopic guidance. We compared the occurrence of Horner's syndrome, the side effects and the changes of temperature of the skin of the hand. Results: The rate of Horner's syndrome was 81.5% in the group I and 84.2% in the group II. The rate of incurring increased skin temperature (${\geq}34^{\circ}C$) of the fingers was 77.7% and 79.4% in each group, respectively. Conclusions: The C7 oblique approach for SGB showed the same SGB effect compared with the C7 anterior approach for SGB, and there were also fewer complications. We conclude that C7 oblique SGB may be a beneficial method for treating patients with this particular malady.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.26-31
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• 2001

Background: Sympathetic blocks with local anesthetics are used to differentiate sympathetically- maintained pain (SMP) from sympathetically-independent pain (SIP). However, systemic lidocaine is also used in the management of neuropathic pain. Therefore, there may be possibility of a false positive response in relieving their pain by systemic absorption of lidocaine following a diagnostic sympathetic block in patients with SIP. In this study, we measured the plasma lidocaine concentrations after a stellate ganglion block (SGB) using three volumes of 1% lidocaine. Methods: This prospective, crossover study was performed in 3 patients who experience sudden hearing loss and in 4 volunteers. Each person received SGB three times using three different volumes (6 ml, 12 ml and 16 ml) of 1% lidocaine at one week intervals. SGB was performed using a 23 G butterfly needle via a paratracheal approach by two persons. Two ml of venous blood was obtained from a prepared contra-lateral sided venous route at 1, 3, 5, 7, 10, 20 and 60 min after SGB. Plasma lidocaine level was analyzed by immunoassay. Results: Mean plasma lidocaine concentrations correlated well with the volumes of 1% lidocaine used in SGB; larger volumes showed higher concentrations (P < 0.01). Mean peak plasma concentrations were $1.08{\pm}0.18$ in 6 ml, $1.90{\pm}0.47$ in the 12 ml and $2.74{\pm}0.67{\mu}g/ml$ in the 16 ml groups (P < 0.01). The mean time to reach peak plasma concentration was not significantly different between the three groups. Conclusions: The peak plasma lidocaine concentrations in SGB using large volume were found to be similar to that of IV lidocaine infusion in the management of neuropathic pain. These data suggest that diagnostic sympathetic block may result in many false positive responses for SMP. Part of its effect may be related to systemic local anesthetic absorption and not to a sympathetic block. Therefore, physicians may be required to use optimal volumes and minimal concentration of local anesthetic in diagnostic sympathetic block procedures and also make a careful assessment of the performance of a permanent sympathetic block.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.30-35
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• 1998

Background: Idiopathic sudden sensorineural hearing loss(ISSHL) has been generally defined as an abrupt loss of auditory acuity without precipitating factors. Since ISSHL was first described as a disease entity, numerous reports assessing a variety of treatment regimens have been published. But its etiology, pathogenesis, treatment, and prognosis are controversial at the present time. Stellate ganglion block(SGB) has been used for the treatment of ISSHL by vasodilatation and increased blood flow to the inner ear. Methods: We reviewed the records of 152 patients to investigate the efficacy of SGB for ISSHL. The control group was managed with medications such as hypaque, heparin, steroid, nicotinic acid, and vitamins. The SGB group was managed with SGB and the same medications. SGB was performed with 8 ml of 1.0% mepivacaine. The efficacy of treatment was evaluated by pure-tone average following therapy. The recovery of hearing was defined as Siegel's criteria I, II, or III. Results: The recovery rate of the SGB group was higher than that of the control group(61.5 vs. 42.9%, p<0.05). The recovery rate was higher in patients who were treated early, within 7 days from the onset of symptoms, especially in the SGB group(79.7%). And in the case that initial hearing loss was severe (>70dB), the SGB group had a higher recovery rate(64.2%) than the control group(42.5%). Conclusions: SGB is thought to be a useful therapy for ISSHL, especially in the patients who were treated soon after onset or whose initial hearing loss was severe.

• The Journal of Internal Korean Medicine
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• v.25 no.3
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• pp.669-676
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• 2004

Post-herpetic neuralgia(PHN) is a chronic pain syndrome associated with the reactivation of a primary infection with varicella zoster virus(chinken pox), which leads to a chronic infection of dorsal root ganglia. The most common risk factor for shingles and its potential sequela, PHN, is advanced age. For a significant number of patients, the pain following healing of shingles can persist for months to years. If this pain, classified as PHN, persists longer than one month. PHN often leads to depression, disrupted sleep, decreased productivity, and utilization of health care. We treated a 60 year-old female patient who suffered pain and headache after Stellate Ganglion Blocks(SGB). In identifying points for differentiation of syndrom(辨證), this subject was diagnosed as Yangmyeong Merdian wind-heat syndrom(陽明經風熱證) and was administered Seungmagalgeuntanggamibang(revised Shengmagalgen-tang, 升麻葛根湯加味方). To ease pain, Western medication was administered as well. After fourteen days of treatment, pain and other symptoms improved.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.57-62
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• 1996

Stellate ganglion block(SGB) improves cutaneous blood flow of the head and neck region and upper extremity. For this reason, SGB has been performed in neural and circulatory disorders. But there is controversy on the cerebral blood flow regulation by sympathetic innervation. We investigated the hypothesis that cerebral blood flow could be affected by blocking ipsilateral sympathetic innervation of cerebral blood flow could be affected by blocking ipsilateral sympathetic innervation of cerebral vasculature. In 10 volunteers, the blood flow velocity and pulsatility index(PI) of middle cerebral artery(MCA) was measured using Transcranial Doppler Flowmeter, before and 15 minutes after SGB, at block side and opposite side. The blood flow velocity of MCA at block side was increased from $62.60{\pm}7.60$ cm/s to $72.80{\pm}8.01$ cm/s(P<0.01) and the PI at block side decreased from $0.75{\pm}0.12$ to $0.60{\pm}0.11$(P<0.05). But the blood flow velocity and PI at opposite side did not change. This study demonstrated that the cerebral blood flow could be increased by SGB, the preganglionic nerve fibers of which synapse with other cervical sympathetic ganglions.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.202-206
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• 2006

Background: Stellate ganglion block (SGB) might be associated with changes in the blood pressure (BP) and heart rate (HR). The heart rate variability (HRV) shows the balance state between sympathetic and parasympathetic activities of the heart. The changes in these parameters of the HRV were studied to evaluate the possible mechanism of SGB in changing the BP. Methods: SGB was performed on 26 patients, using a paratracheal technique at the C6 level, and 8 ml of 1% mepivacaine injected. The success was confirmed by check the Horner's syndrome. The BP, HR and HRV were measured before and 5, 15, 30, 45 and 60 minutes after the SGB. Results: The increases in the BP from the baseline throughout the study period were statistically, but not clinically significant. The HR and LF/HF (low frequency/high frequency) ratio were increased at 5 and 45 min, respectively, after the administration of the SGB. In a comparison of left and right SGB, no significant differences were found in the BP, HR and HRV. A correlation analysis showed that an increased BP was significantly related with the changes in the LF/HF ratio and LF at 15 and 30 minutes, respectively, after the SGB. Dividing the patients into two groups; an increased BP greater and less than 20% of that at the baseline INC and NOT groups, respectively, hoarseness occurred more often in the INC group (P = 0.02). Conclusions: It was concluded that SGB itself does not clinically increase the BP and HR in normal hemodynamic patients. However, the loss of balance between the sympathetic and parasympathetic nerve system, attenuation of the baroreceptor reflex and hoarseness are minor causes of the increase in the BP following SGB; therefore, further studies will be required.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.197-201
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• 2006

Background: There are cases in which shoulder pain persists long after shoulder joint surgery and this pain can not be reduced by intravenous patient controlled analgesia (IVPCA). Our purpose was to evaluate the effect of stellate ganglion block (SGB) on postoperative shoulder pain and also to investigate the effect of preventive SBG on complex regional pain syndrome (CRPS). Methods: Forty patients, who were evaluated to ASA class 1 and 2 and who were scheduled for shoulder joint surgery under general anesthesia, were randomly divided into 2 groups. The experimental group of patients (n = 20) received SGB with 0.5% mepivacaine 8 ml after induction of general anesthesia. The control group of patients (n = 20) received only general anesthesia. Their postoperative pain was assessed using the visual analog scale (VAS) at 30 min, 1, 2, 6, 12, 24 and 48 hours postoperatively. Whenever patients wanted supplemental analgesia, diclofenac sodium 75 mg was injected intramuscularly and the need for supplemental analgesia was recorded. Results: The experimental group of patients had significantly lower pain scores at 30 min, 1, 2 and 6 hours and also significantly lower analgesic requirement at 1, 2 and 6 hours. Conclusions: We found SGB was effective for controlling postoperative pain after shoulder joint surgery. Also, we could expect that SGB reduced the incidence of CRPS.