Devulder J, De Laat M, Rolly G
Department of Anesthesia Pain Clinic, University Hospital of Ghent, Belgium.
Reg Anesth. 1997 May-Jun;22(3):284-6. doi: 10.1016/s1098-7339(06)80016-7.
The chronic intestinal pseudo-obstruction due to visceral myopathy is a disorder resembling bowel obstruction but without mechanical occlusion. Frequently, parenteral nutrition becomes the final palliative treatment. A patient affected with this syndrome for 16 years was suffering causalgic pain provoked by intraveneous perfusion. Stellate ganglion block was requested in the hope of maintaining the perfusion.
Stellate ganglion block not only stopped the pain but unexpectedly, it temporarily relieved the pseudo-obstruction symptoms. Two radiofrequency coagulations in the stellate ganglion prolonged the beneficial effects on gastrointestinal transit for more than 3 weeks, after which the symptoms returned. Multidisciplinary and multicenter advice was that further destructive treatments not be attempted.
Repetitive stellate ganglion blocks with 2 mL of bupivacaine 0.75% restored gastrointestinal function for more than 3 weeks. However, after performance of radiofrequency coagulation, infiltration with bupivacaine was followed by hypermetropia on the right eye of 2 weeks duration.
The relationship between stellate ganglion block and gastrointestinal function has not been described. This case report does not provide sufficient information to recommend this technique for pseudo-obstruction symptoms. Moreover, the result in this case is a fortuitous observation, lacking a clear scientific explanation. Further study may be warranted.
内脏肌病所致慢性肠道假性梗阻是一种类似肠梗阻但无机械性梗阻的疾病。通常，肠外营养成为最终的姑息治疗方法。一名患有该综合征16年的患者因静脉输注引发灼性神经痛。患者要求进行星状神经节阻滞，以期维持输液。
星状神经节阻滞不仅止住了疼痛，而且出乎意料地暂时缓解了假性梗阻症状。对星状神经节进行两次射频消融，延长了对胃肠转运的有益作用，持续超过3周，之后症状复发。多学科和多中心的建议是不再尝试进一步的毁损性治疗。
用2毫升0.75%布比卡因反复进行星状神经节阻滞可使胃肠功能恢复超过3周。然而，在进行射频消融后，布比卡因浸润后右眼出现了持续2周的远视。
星状神经节阻滞与胃肠功能之间的关系此前尚未见报道。本病例报告未提供足够信息来推荐将该技术用于假性梗阻症状。此外，该病例结果是一次偶然观察，缺乏明确的科学解释。可能需要进一步研究。
