• 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.9 no.1
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• pp.223-225
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• 1996

Pain arising from disorders of the viscera and somatic structures within the pelvis and perineum is a frequent cause of discomfort and disability, especially among women. Recently, blockade of the ganglion impar(ganglion of Walther) has been introduced as an alternative means of managing intractable perineal pain of sympathetic origin. The first report of interruption of the ganglion impar for relief of perineal pain appeared in 1990. We successfully treated a patient who had suffered from intermittent severe coccygodynia with ganglion impar block.

• Molecules and Cells
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• v.37 no.11
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• pp.804-811
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• 2014

The protease-activated receptor (PAR)-2 is highly expressed in endothelial cells and vascular smooth muscle cells. It plays a crucial role in regulating blood pressure via the modulation of peripheral vascular tone. Although several mechanisms have been suggested to explain PAR-2-induced hypotension, the precise mechanism remains to be elucidated. To investigate this possibility, we investigated the effects of PAR-2 activation on N-type $Ca^{2+}$ currents ($I_{Ca-N}$) in isolated neurons of the celiac ganglion (CG), which is involved in the sympathetic regulation of mesenteric artery vascular tone. PAR-2 agonists irreversibly diminished voltage-gated $Ca^{2+}$ currents ($I_{Ca}$), measured using the patch-clamp method, in rat CG neurons, whereas thrombin had little effect on $I_{Ca}$. This PAR-2-induced inhibition was almost completely prevented by ${\omega}$-CgTx, a potent N-type $Ca^{2+}$ channel blocker, suggesting the involvement of N-type $Ca^{2+}$ channels in PAR-2-induced inhibition. In addition, PAR-2 agonists inhibited $I_{Ca-N}$ in a voltage-independent manner in rat CG neurons. Moreover, PAR-2 agonists reduced action potential (AP) firing frequency as measured using the current-clamp method in rat CG neurons. This inhibition of AP firing induced by PAR-2 agonists was almost completely prevented by ${\omega}$-CgTx, indicating that PAR-2 activation may regulate the membrane excitability of peripheral sympathetic neurons through modulation of N-type $Ca^{2+}$ channels. In conclusion, the present findings demonstrate that the activation of PAR-2 suppresses peripheral sympathetic outflow by modulating N-type $Ca^{2+}$ channel activity, which appears to be involved in PAR-2-induced hypotension, in peripheral sympathetic nerve terminals.

• The Korean Journal of Pain
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• v.21 no.2
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• pp.119-125
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• 2008

Background: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglia (SCG), and these nerves may influence the cerebral blood flow. The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats that were subjected to focal cerebral ischemia/reperfusion injury. Methods: Eighty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of two groups (the ropivacaine group and a control group). In all the animals, brain injury was induced by middle cerebral artery (MCA) reperfusion that followed MCA occlusion for 2 hours. The animals of the ropivacaine group received $30{\mu}l$ of 0.75% ropivacaine, and their SCG. Neurologic score was assessed at 1, 3, 7 and 14 days after brain injury. Brain tissue samples were then collected. The infarct ratio was measured by 2.3.5-triphenyltetrazolium chloride staining. The terminal deoxynucleotidyl transferase mediated dUTP-biotin nick-end labeled (TUNEL) reactive cells and the cells showing caspase-3 activity were counted as markers of apoptosis at the caudoputamen and frontoparietal cortex. Results: The death rate, the neurologic score and the infarction ratio were significantly less in the ropivacaine group 24 hr after ischemia/reperfusion injury. The number of TUNEL positive cells in the ropivacaine group was significantly lower than those values of the control group in the frontoparietal cortex at 3 days after injury, but the caspase-3 activity was higher in the ropivacaine group than that in the control group at 1 day after injury. Conclusions: The study data indicated that a superior cervical sympathetic ganglion block may reduce the neuronal injury caused by focal cerebral ischemia/reperfusion, but it may not prevent the delayed damage.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.263-269
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• 1994

Causaliga is a syndrome of sustained burning pain, allodynia and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes. Various treatments of causalgia contain sympathetic blockade, sympathectomy, transcutaneous electrical nerve stimulation, physical therapy, cryotherapy and psychotherapy. Repeated stellate ganglion blocks with 6ml of 0.25% bupivacaine provided good results for 2 patients. We recommand sympathetic blocks for treatment of causalgia.

• The Korean Journal of Pain
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• v.1 no.2
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• pp.171-176
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• 1988

It is well known that the celiac plexus block is specially useful for relieve intractable upper abdominal pain caused by upper abdominal visceral malignancy or upper abdominal metastasis from distant organs. But in cases of lower abdominal or pelvic metastasis from upper abdominal malignancy, the lower abdominal intractable pain is remained after the successful celiac plexus block. We have reported 7 cases of celiac plexus block combined with lumbar sympathetic ganglion block, among the 305 cases of the celiac plexus block from 1968 to Nov. 1987, performed in patients with lower abdominal or back pain due to carcinomatosis of lower abdominal metastatic malignancy, that their results were excellent for pain relief.

• The Korean Journal of Pain
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• v.7 no.1
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• pp.96-99
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• 1994

Causalgia is a symptom complex usually consisting of burning pain, hyperesthesia and atrophy of the involved extremity. The pain may be aggravated by contact, motion of extremity or emotional excitement. It occurs following incomplete nerve injury. The patient was a 58-year-old male with a 3-year history of causalgic pain of left lower extremity. He had multiple fractures with degloving injury of left lower extremity in an automobile accident. The pain was exacerbated by movement, and he experienced knee joint and ankle joint contracture. The patient's pain decreased after continuous epidural block with 1% lidocaine and 0.25% bupivacaine. He also received lumbar sympathetic ganglion alcohol block resulting in much improvement of level of pain and walking disturbance.

• Journal of Korean Neurosurgical Society
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• v.41 no.1
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• pp.27-29
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• 2007

Objective : Surgical treatment of focal plantar hyperhidrosis is often unsatisfactory compared to palmar hyperhidrosis. The purpose of this study is to evaluate the effect of lumbar sympathetic radiofrequency neurotomy on plantar hyperhidrosis. Methods : From February 2004 to December 2005, 10 patients [mean age 24.3 male 1, female 9] with the clinical diagnosis of plantar hyperhidrosis were treated by bilateral lumbar sympathetic radiofrequency neurotomy of L3 and L4. Patients' symptom relief, satisfactory rate and side effects related to the procedure were analyzed. Results : Radiofrequency neurotomy was effective in the treatment of focal plantar hyperhidrosis showing excellent [more than 75% improved] outcome in 70% of the patients and good [more than 50% improved] in 30%. Complications related to the surgical procedure, such as sensory dysesthesia and compensatory hyperhidrosis were not detected in any case. Conclusion : The use of radiofrequency neurotomy to ablate the lumbar sympathetic ganglion is a safe and effective treatment option for patients with plantar hyperhidrosis.

• Journal of Korean Neurosurgical Society
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• v.56 no.1
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• pp.66-70
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• 2014

Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion block with a significant relief of his pain. The second patient complained of a cold sensation and severe unexpected pain in the lower extremity of the contralateral side after anterior lumbar interbody fusion and was treated with lumbar sympathetic block. We aimed to describe sympathetically maintained pain as one of the important causes of early postoperative pain and the treatment option chosen for these cases in detail.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.115-118
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• 2006

Among the sympathetic blocks used to treat various symptoms and diseases, including sympathetic dysfunction in pain clinics, a stellate ganglion block (SGB) is one of the easiest to apply. However, it is difficult to evaluate the effects of SGB due to the subjective nature of patient-reported data. A 26-year-old female, who presented with symptoms of coldness and sweating on both hands, received SGB 25 times on each side over a 2-month period. The effects of SGB were followed up using a cold stress test with thermography. Although the symptoms appeared again after 6 months, the recovery rate of the palmar temperature after the cold stress test improved significantly and was maintained for 18 months.