• 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.14 no.1
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• pp.93-97
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• 2001

Facial nerve palsy is not a serious disease, but it can be both upsetting and disabling for patients. More than half of the lesions of facial nerve palsy fall into the category termed Bell's palsy. It is very rare to find a representative case of bilateral Bell's palsy. Here we report the changes of infrared thermographic findings in bilateral Bell's palsy treated with a stellate ganglion block (SGB). A 45-year-old female patient who had a right facial palsy which developed 2 weeks before. Steroid administration and acupuncture was not effective and so she was referred to pain clinic. The right facial palsy was cured after 19th right SGB. Twenty eight days after the onset of the right facial palsy, left facial palsy also developed and cured completely with a left SGB. Serial infrared thermograms were performed. The hypothermias on the affected side improved symmetrically by the end of the treatment.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.326-331
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• 1998

Facial nerve paralysis is a common pain clinical diagnosis. But ipsilateral or contralateral recurrent facial paralysis is found in about 2.6~19.5% of facial paralysis and especially bilateral facial paralysis is rare. While idiopathic facial paralysis is the most common diagnosis, a comprehensive evaluation must be completed prior to this diagnosis in patients with bilateral facial paralysis. A representative case of bilateral alternating facial paralysis treated with stellate ganglion block (SGB) is presented. A 57 years old male patient who had the onset of a right facial paralysis 7 months ago visited pain clinic. Five months after the onset of right facial paralysis, as it was improving, he developed a left facial paralysis. He had history of hypertension, diabetus mellitus and pain episode on mastoid process before facial paralysis developed. Electrical test showed incomplete neuropathy on both side and computed tomography (CT) scan was normal. He was treated with SGB, physical theraphy and aspirin medication. After 25 times SGB, he was recovered almost completely.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.124-126
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• 1995

Atopic allergy implies a familial tendency to manifest alone or in combination such as asthma, rhinitis, urticaria and atopic dermatitis. The patient with atopic dermatitis shows a variety of humoral and cell-mediated immune dysfunction, including an elevation of serum IgE level, multiple positive immediate skin tests to a variety of antigen. A 30 year old female patient suffering from an atopic dermatitis on face, has been administered a stellate ganglion block(SGB) with a 1% mepivacaine 5cc. She complained of bronchial hyperresponsivness such as cough, soreness, and inspiration difficulty for 5 days following the treatment, so we have reduced 1% mepivacaine dose from 5cc to 3cc. She had no complain of bronchial hyperresponsivenss and the lesion of atopic dermatitis was improved. From our result we conclude that SGB appears to be a good choice for the treatment of the atopic dermatitis and only 1% mepivacaine 3cc is possible in complete SGB.

• The Korean Journal of Pain
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• v.13 no.2
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• pp.187-190
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• 2000

Background: From our clinical experience, there were some problems in paratracheal stellate ganglion block at 6th cervical level (C 6 SGB), for example, lesser change in blood flow of the upper extremity and more occurrence of hoarseness. This study was undertaken to compare the various effectiveness of C 6 SGB and paratracheal stellate ganglion block at 7th cervical level (C 7 SGB). Methods: Forty patients were equally divided into 2 groups. In the Group I, patients were undertaken C 6 SGB with 0.25% bupivacaine 6 mL and in the Group II, patients were undertaken C 7 SGB with 0.25% bupivacaine 6mL. The skin temperature of index finger was measured before and after SGB and the warm sensation on face and upper extremity, hoarseness and upper extremity paralysis were studied. Results: The skin temperature of index finger was increased significantly from $33.95{\pm}0.89^{\circ}C$ to $34.51{\pm}0.90^{\circ}C$ in the Group I and from $33.94{\pm}0.82^{\circ}C$ to $35.38{\pm}0.66^{\circ}C$ in the Group II (P<0.05) The increase of skin temperature of index finger after procedure was $0.56{\pm}0.09^{\circ}C$ in the Group I and $1.44{\pm}0.02^{\circ}C$ in the Group II. The increase of skin temperature of index finger in the Group II was more statistically significant than Group I (P<0.05). The occurance of hoarseness in the Group II was significantly less than in the Group I. There was no significant difference in warm sensation on face and upper extremity and paralysis of upper extremity in both Groups. Conclusions: C 7 SGB showed better sympathetic block effect on upper extremity than C 6 SGB and hoarseness did not occur in C 7 SGB.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.65-73
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• 1995

Idiopathic sudden sensorineural hearing loss(SNHL) is defined as a sensorineural hearing loss which develops over a period of hours or few days without a definitive causes. The etiology, prognosis, and treatment of SNHL are uncertain. We reviewed records of 76 patients to investigate the efficacy of the stellate ganglion block(SGB)in SNHL. The control group(40 patients) was managed with the medication such as hypaque, heparin, steroid, nicotinic acid, and vitamine. The SGB group(27 patients) was managed with the same medication and SGB (1~2 times/day). The efficacy of treatment was evaluated by mean dB of 500, 1000, 2000 Hz on follow up pure tone audiogram. Recovery rate above 15dB was not different between SGB and the control group (52.4 v.s. 52.0%), though SGB group has much poor prognostic factors. Recovery rate was higher in a case that was treated early. Especially, the recovery rate was 100% when SGB begins within 2 weeks from the onset. Headache and profound type of audiogram were poor prognostic factors. In conclusion, SGB within 2 weeks from the onset is recommanded to improve the recovery rate.

• 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 Korean Journal of Pain
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• v.10 no.1
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• pp.101-103
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• 1997

Common oral lesions of lichen planus (LP) are bilateral lace-like white patches in the buccal and lingual mucosae. Oral LP of chronic erosive and ulcerative forms develop carcinomas among approximately 1% of affected patients. A 64 year old male patient suffering from LP with early verrucous carcinoma on lips, tongue, and hard palate for approximately 8 years was refered to the pain clinic from department of dermatology. He complained of severe pain (VAS 9.5) on lips, oral cavity and left of the face. For 18 consecutive days we performed stellate ganglion blocks (SGB) with 6 ml on his left side of face. Patients pain decreased to (VAS 3.0) after 18 SGB. After a total of 31 SGB patient was discharged free of pain. pain recurred (VAS 3.5) 22 days after discharge. We then performed SGB, twice weekly and pain was effectively relieved after total 54 SGB. But patient needed to take oral analgesics due to nocturnal pain.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.58-63
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• 1997

Background : Endotracheal intubation is one of the methods most securely establishing airway. But accompanying hemodynamic responses are harmful to coronary or cerebral vascular disease patients. These hemodynamic responses are regarded as the results of sympathetic stimulation due to pharyngolaryngeal stimulation, and sympathetic blocking method-stellate ganglion block- may be obtundate these hemodynamic responses. Methods : 75 patients of ASA physical status I-II were selected. There were 40 patients normotensive (Group I), 35 patients hypertensive (Group II) Group I, steliate ganglion block was performed on 20 patients (Group I-S) the remainder had no procedure (Group I-O). Group II, 18 patients received SG3 (Group II-S), 17 patients had no procedure (Group II-O). SGB was performed with 1% lidocaine 8 ml on right stellate genglion after patient's consent. Blood pressure (IIP) and pulse rate(PR) were first measured in the pre-anesthesia room. Follow up BP and PR are checked immediately following SGB and every 5 minutes for subsequent 20 minutes, then after arrival at operatig room, then immediately after intubation and at 3, 5, 10, 15 and 20 minutes after incubation. Results : All group experienced significantly increased blood pressure and pulse rate upon arrival at the pre-anesthesetic and opeating rooms, as compared to when patients rates in the ward. After intubation and for subsequent 5 minutes, significant changes were measured. Patients then recovered to preblock value. In Group I, no statistical significance was recorded between subgroup I-S and I-O. However in Group II, there were significant differences between sub-group II-S and II-O. In evaluating pulse rate changes, there were no significant differences between Group I-S and I-O; nor II-S and II-O. Conclusion : The proper diagnosis of Stellate Ganglion Block had some measure of protective effect on hemodynamics following endotracheal intubation, especially in hypertensive patients.

• 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.