From the Departments of Anesthesiology and Pain Medicine.
Orthopedic Surgery, College of Medicine, Chung-Ang University, Chung-Ang University Hospital, Seoul, Republic of Korea.
Anesth Analg. 2018 May;126(5):1705-1711. doi: 10.1213/ANE.0000000000002528.
The success of stellate ganglion block (SGB) is traditionally determined on the basis of findings such as Horner's syndrome, temperature rise in the face, hyperemia of the tympanic membrane, and nasal congestion. However, decreases in vascular resistance and increases in blood flow in the arm may be more meaningful findings. To date, the effect of SGB on the regional hemodynamics of the arm has not been evaluated using pulsed-wave Doppler ultrasound.
A total of 52 patients who were to undergo orthopedic surgery of the forearm were randomly assigned to either the mepivacaine group (SGB with 5 mL of 0.5% mepivacaine) or the saline group (SGB with 5 mL of normal saline). Before surgery, a single anesthesiologist performed a SGB under ultrasound guidance. The temperature of the upper extremity and the resistance index and blood flow in the brachial artery were measured before SGB, 15 and 30 minutes after SGB, and 1 hour after surgery. The severity of pain, requirement for rescue analgesics, and side effects of the local anesthetic agent were all documented.
After SGB, the resistance index decreased significantly and the blood flow increased significantly in the brachial artery of members of the mepivacaine group (15 minutes: P = .004 and P < .001, respectively; 30 minutes: P < .001 and P < .001, respectively). However, these values normalized after surgery. The severity of pain, need for rescue analgesics, and incidence of adverse effects were not significantly different between the 2 groups.
Although SGB did not decrease the pain associated with forearm surgery, ultrasound-guided SGB did increase blood flow and decrease vascular resistance in the arm. Therefore, pulsed-wave Doppler may be used to monitor the success of SGB.
传统上，星状神经节阻滞（SGB）的成功是基于霍纳综合征、面部温度升高、鼓膜充血和鼻塞等发现来确定的。然而，血管阻力的降低和手臂血流量的增加可能是更有意义的发现。迄今为止，还没有使用脉冲波多普勒超声评估 SGB 对手臂区域血液动力学的影响。
共有 52 名拟行前臂骨科手术的患者被随机分为甲哌卡因组（SGB 注射 5mL0.5%甲哌卡因）或生理盐水组（SGB 注射 5mL 生理盐水）。手术前，由一名麻醉医生在超声引导下进行 SGB。在 SGB 前、SGB 后 15 分钟和 30 分钟以及手术后 1 小时测量上肢温度以及肱动脉阻力指数和血流。记录疼痛严重程度、需要解救性镇痛药物以及局麻药的副作用。
在 SGB 后，甲哌卡因组患者的肱动脉阻力指数显著降低，血流量显著增加（15 分钟：P =.004 和 P <.001；30 分钟：P <.001 和 P <.001）。然而，这些值在手术后恢复正常。两组之间疼痛严重程度、需要解救性镇痛药物以及不良反应的发生率均无显著差异。
尽管 SGB 并未减轻与前臂手术相关的疼痛，但超声引导的 SGB 确实增加了手臂的血流量并降低了血管阻力。因此，脉冲波多普勒可能用于监测 SGB 的成功。
