Clinic of Anesthesiology and Intensive Care Medicine, Pain Center, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
Pain Pract. 2020 Jul;20(6):626-638. doi: 10.1111/papr.12892. Epub 2020 May 17.
Evaluating the effectiveness of stellate ganglion blockades (SGBs) proves challenging, since the criteria defining a successful blockade are controversial. This may be one reason for the scarcity of studies on this topic, thus forcing clinical guidelines to remain conservative in recommending SGBs. Moreover, factors to predict which patients will benefit from blockade series are not yet available.
The objectives of this study were to evaluate through a clinical approach SGBs' effectiveness performed under ultrasound guidance (us-SGB) and to identify factors to predict effectiveness.
We retrospectively analyzed 809 us-SGBs in 105 patients with complex regional pain syndrome (CRPS) and neuropathic pain syndromes (all potentially including sympathetically maintained pain) regarding pain reduction. Volume and type of local anesthetics, magnitude of pain, temperature of the dorsal hands, heart rate, blood pressure, and occurrence of Horner's syndrome or complications were assessed.
Pain reduction after a blockade series was highly significant and showed no significant correlation with change of temperature, vital signs, or Horner's syndrome. For patients with neuropathic pain, the predictive potential for pain reduction following a blockade series lies within the range of pain reduction after the first blockade. In a literature comparison, incidences of complications (hoarseness 3.9%, dysphagia 3.4%, hematoma 0.6%) were lower than in non-ultrasound-guided techniques.
Data indicate that us-SGBs are safe and effective in reducing sympathetically maintained pain in patients with CRPS and neuropathic pain syndromes. Pain reduction after the first blockade may predict total pain reduction after a blockade series. Other clinical measures seem unsuitable to predict effectiveness.
由于定义成功阻滞的标准存在争议，评估星状神经节阻滞 (SGB) 的效果具有挑战性。这可能是该主题研究稀缺的原因之一，因此迫使临床指南在推荐 SGB 时保持保守。此外，预测哪些患者将从阻滞系列中受益的因素尚不可用。
本研究的目的是通过临床方法评估超声引导下 SGB（us-SGB）的有效性，并确定预测有效性的因素。
我们回顾性分析了 105 例复杂性区域疼痛综合征 (CRPS) 和神经性疼痛综合征患者（所有患者均可能存在交感维持性疼痛）的 809 例 us-SGB，以评估疼痛缓解情况。评估局部麻醉剂的体积和类型、疼痛程度、手背温度、心率、血压以及霍纳氏综合征或并发症的发生情况。
阻滞系列后的疼痛缓解程度具有高度显著性，且与温度变化、生命体征或霍纳氏综合征无显著相关性。对于患有神经性疼痛的患者，阻滞系列后疼痛缓解的预测潜力存在于第一次阻滞后的疼痛缓解范围内。与非超声引导技术相比，并发症（声音嘶哑 3.9%、吞咽困难 3.4%、血肿 0.6%）的发生率较低。
数据表明，us-SGB 可安全有效地减轻 CRPS 和神经性疼痛综合征患者的交感维持性疼痛。第一次阻滞后的疼痛缓解程度可能预测阻滞系列后的总疼痛缓解程度。其他临床措施似乎不适合预测有效性。
