Stellate ganglion block (BGE) is a technique that, although not 100% effective, is performed for pain control in patients with complex regional pain syndrome (CRPS).
Complex regional pain syndrome is a disease that in 65% -90% of cases develops after trauma, and is characterized by the presence of incapacitating, regional, spontaneous or induced pain, accompanied by autonomic changes such as alterations in the temperature, sweating, coloration and edema.
Often, these alterations lead to a total loss of joint movement, leading to irreversible functional impairment of the compromised limb. Multiple treatments have been proposed for the management of CRPS, many of them based on anecdotal observations and not on controlled clinical studies. The use of anticonvulsants, tricyclic antidepressants, regional or intravenous sympathetic blocks, using local anesthetics, guanethidine, reserpine, acupuncture, spinal electrical stimulation, and others have been proposed.
What is Stellate Ganglion Block or Lumbar and Cervical Sympathetic Block?
The sympathetic nervous system is responsible for regulating the homeostatic mechanisms of living organisms. The fibers of this system reach almost every organ and system in the body, from the pupil of the eye to controlling intestinal motility. This is the system that mediates the hormonal stress response. Fighting and flight behaviors are mediated by the sympathetic system. Increases the frequency of heartbeat, dilates the bronchi and pupils. Stimulates the adrenal glands. Excessive sweating or hyperhidrosis in the hands, armpits, or face is related to hyperstimulation of the sympathetic system. The sympathetic system helps us to feel the sensations of cold or heat. It also controls blood flow and digestion.
An injury or dysfunction of the sympathetic nervous system can also be the cause of pain, and more frequently affects the hands and feet, although pain can also appear at other levels.
When can a nerve block be used?
A sympathetic nerve block can be used to diagnose or treat pain that involves the nerves of the sympathetic nervous system. Examples of conditions for which a sympathetic nerve block could be used include:
· Pain from spasms in blood vessels after frostbite.
· Complex regional pain syndrome, previously called reflex sympathetic dystrophy and causalgia.
Raynaud's syndrome.
· Some types of chronic abdominal pain.
Excessive sweating, called hyperhidrosis
Sympathetic chain block procedure
The location of your pain usually determines where the blockage will take place. The sympathetic nerves unite outside the spine forming networks of nerves and ganglia, which are distributed on both sides of the vertebrae throughout the entire spinal column. If you have pain in your upper body, pain relief can be obtained with a stellate ganglion block in the neck area. If the pain affects the lower part of the body, a lumbar or hypogastric sympathetic block will be performed if it affects the perineal area.
To perform a sympathetic block procedure
You will be cared for by a pain management specialist experienced in performing sympathetic nerve blocks. You will be asked to fast for about six hours before the procedure. Your doctor will ask about your medical history, all the medications you are taking, and if you have any allergies.
Before the procedure begins, an IV is placed and vital signs are monitored. You may be given sedation medication so that it is not unpleasant or painful. A local anesthetic is injected into the area on the neck or back to be treated. Use ultrasound to locate the node.
Once the node is located, another anesthetic is administered and sometimes other substances such as alcohol or phenol are used.
After treatment the nerve block
A sympathetic chain block is a relatively safe procedure. After injecting the medication, you will be transferred to the observation room and after a reasonable time, normally 30-60 minutes, you can go home later. The next day you can return to your normal activities. It is recommended that someone accompany you to return home.
Side effects after a sympathetic block may include temporary pain in the area of
injection, a feeling of warmth or weakness in the arms or legs for a few hours. If you have received a stellate ganglion nerve block, you may experience some temporary voice changes, drooping of the eyelid, or difficulty swallowing. Start at 2 hours to see if he can tolerate liquids, because sometimes you have to wait 3-4 hours until you can eat.
You can take your usual medication and pain relievers and have pain. In most cases, a series of three to six blocks is performed to get the best possible response.
Sympathetic blocks do not work for all patients, and the pain relief they provide may decrease over time. However, for some, a sympathetic block can provide weeks or months of pain relief.
Source: Rodríguez RF, Bravo LE et al. Determination of the analgesic efficacy of stellate ganglion blocks in the relief of pain mediated by the sympathetic nervous system in patients with complex regional pain syndrome of the upper limb. Rev Col Anest 2005; 33: (3). www.scare.org
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