Shanthanna Harsha
Department of Anesthesiology, McMaster University, Health Sciences Centre 2U1, 1200 Main Street West, Hamilton, ON, Canada L8N 3Z5.
Case Rep Med. 2013;2013:293826. doi: 10.1155/2013/293826. Epub 2013 Aug 26.
We present this report of a young patient with chronic severe atypical facial pain who was successfully controlled with stellate ganglion block under ultrasound guidance. The patient had a history of severe disabling, unilateral, facial neuropathic pain with minimal response to analgesic medications. Upon assessment the patient had features suggestive of trigeminal neuralgia, although postherpetic neuralgia could not be ruled out. As a diagnostic test intervention, stellate ganglion block was tried under ultrasound guidance. The patient showed significant improvement in pain control and functional disability lasting beyond 10 weeks. Subsequent blocks reinforced the analgesia. Atypical facial pain has several differential diagnoses. The involvement of sympathetic system in its causation or sustenance is uncertain. Stellate ganglion block achieves sympathetic block of cervicofacial structures, and its blockade has been shown to affect chronic pain conditions. Although its mechanism is not clear, one has to consider its possible role in conditions of stress apart from directly controlling the sympathetic activity. There is certainly a role in exploring the potential benefits of stellate ganglion block in such clinical conditions. The technique of stellate block under ultrasound is also described, as it influences the safety and precision of the block.
我们报告了一例患有慢性重度非典型面部疼痛的年轻患者，其疼痛在超声引导下的星状神经节阻滞治疗后成功得到控制。该患者有严重的、致残性的单侧面部神经病理性疼痛病史，对止痛药物反应甚微。经评估，患者具有三叉神经痛的特征，尽管不能排除带状疱疹后神经痛。作为一种诊断性试验干预措施，在超声引导下尝试进行星状神经节阻滞。患者的疼痛控制和功能障碍有显著改善，且持续超过10周。随后的阻滞加强了镇痛效果。非典型面部疼痛有多种鉴别诊断。交感神经系统在其病因或维持过程中的参与情况尚不确定。星状神经节阻滞可实现颈面部结构的交感神经阻滞，并且已表明其阻滞作用可影响慢性疼痛状况。尽管其机制尚不清楚，但除了直接控制交感神经活动外，还必须考虑其在应激状态下可能发挥的作用。在这类临床情况下探索星状神经节阻滞的潜在益处肯定是有意义的。本文还描述了超声引导下星状神经节阻滞技术，因为它会影响阻滞的安全性和精确性。
