Kim Hyuckgoo, Song Sun Ok, Jung Gul
Department Anesthesiology and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, 170, Hyeonchung-ro, Nam-Gu, Daegu, 705-703, Republic of Korea.
J Anesth. 2017 Jun;31(3):458-462. doi: 10.1007/s00540-017-2354-y. Epub 2017 Apr 28.
Recent reports suggest that ultrasound-guided stellate ganglion block (SGB) is safer and more accurate than classic SGB by the using the surface anatomical landmark. However, previous reports concern the classic paratracheal approach using a small specialized curved probe, which may not be appropriate in some patients. The authors have attempted several approaches, including paratracheal, trans-thyroidal, lateral paracarotid, and lateral approaches, to find a safe and suitable method for real-time ultrasound-guided SGB using a standard high-frequency linear probe. A total of 27 injections were performed on 27 patients with sensorineural hearing loss. The lateral paracarotid out-of-plane and lateral in-plane approaches were identified as the easiest and safest methods among the four tested. In this report, we describe a new lateral paracarotid approach for ultrasound-guided SGB. An ipsilateral paratracheal short-axis transverse scan was acquired at the C6 level with a linear probe (6-13 MHz). The probe was moved laterally, scanning the thyroid, carotid artery, internal jugular vein, longus colli muscle, and the transverse process of the C6, placing the carotid artery in the middle of the view. Light pressure was applied to the probe postero-medially to displace the carotid artery medially and completely compress the internal jugular vein. The needle was inserted out-of-plane between the lateral margin of the carotid artery and Chassaignac's tubercle, traversing the collapsed internal jugular vein, and targeted between the longus colli muscle and the prevertebral fascia. A total of 4 ml of 0.2% ropivacaine was injected for each procedure after a negative aspiration test. Successful blockade was confirmed with the onset of Horner's sign. All 27 injections resulted in successful blockade with Horner's sign presenting within 5 min after injection. Side effects were minor and caused minimal discomfort; they included hoarseness and a foreign body sensation. No hematomas formed after any injections. We suggest that this new lateral paracarotid approach, with out-of plane needle insertion at the C6 tubercle under transverse scan, is a convenient and safe method for performing real-time ultrasound-guided SGB, as it provides a wide, safe space for needle passage without risking thyroid or esophageal injury.
近期报告表明，与使用体表解剖标志的传统星状神经节阻滞（SGB）相比，超声引导下的SGB更安全、更准确。然而，既往报告关注的是使用小型专用弯探头的传统气管旁入路，这在某些患者中可能并不适用。作者尝试了多种入路，包括气管旁、经甲状腺、颈动脉旁外侧和外侧入路，以寻找一种使用标准高频线性探头进行实时超声引导下SGB的安全且合适的方法。对27例感音神经性听力损失患者共进行了27次注射。在四种测试方法中，颈动脉旁外侧平面外和平面内入路被确定为最简单、最安全的方法。在本报告中，我们描述了一种用于超声引导下SGB的新的颈动脉旁外侧入路。使用线性探头（6 - 13MHz）在C6水平获取同侧气管旁短轴横向扫描图像。探头向外侧移动，扫描甲状腺、颈动脉、颈内静脉、颈长肌和C6横突，将颈动脉置于视野中央。在探头后内侧施加轻压，将颈动脉向内侧移位并完全压迫颈内静脉。在颈动脉外侧缘和夏塞纳克结节之间平面外进针，穿过塌陷的颈内静脉，目标位于颈长肌和椎前筋膜之间。每次操作在回抽试验阴性后注射4ml 0.2%罗哌卡因。通过霍纳氏征的出现确认阻滞成功。所有27次注射均导致阻滞成功，霍纳氏征在注射后5分钟内出现。副作用轻微，引起的不适最小；包括声音嘶哑和异物感。注射后未形成血肿。我们认为，这种在横向扫描下于C6结节平面外进针的新的颈动脉旁外侧入路，是一种方便且安全的实时超声引导下SGB的方法，因为它为针的通过提供了广阔、安全的空间，而不会有甲状腺或食管损伤的风险。
