The stellate ganglion block (SGB) is a cervical sympathetic nerve block, which is commonly used in clinical treatment.SGB therapy has a long history. Since then, certain diseases have been treated by surgical methods of cutting the cervical sympathetic nerve, and in 1920, the method of percutaneous SGB has been promoted, and it has been used by clinicians because of its wide range of indications and precise effects, especially for some refractory diseases.
At present, in Japan, the application rate of SGB accounts for 60%–80% of all nerve blocks in pain treatment; in China, it is also increasing year by year, and currently accounts for about 50% of all nerve blocks.
I. Application of anatomical stellate ganglion, also known as cervicothoracic ganglion, is formed by the merger of the inferior cervical ganglion and the thoracic 1 ganglion.
It is generally believed that the stellate ganglion is located at the base of the transverse process of the 7th cervical vertebra and the high part of the 1st cervical muscle neck, on the anterior side of the cervical 8 nerve and on the lateral side of the long cervical muscle; the 1st intercostal artery and vein pass through the lateral side of the stellate ganglion; the 1st segment of the subclavian artery and the beginning of the vertebral artery are on the anterior side of the stellate ganglion; the vertebral artery and vein are immediately above it, and the vertebral artery enters the transverse foramen at the level of cervical 6; the anterior oblique muscle tendon membrane almost completely The anterior oblique tendon membrane almost completely covers the stellate ganglion.
Second, the block method anterior approach block method, anterolateral approach block method, lateral approach block method, posterior approach block method, continuous block method, etc..
At present, the most commonly used is the anterior approach block method, which has the advantages of clear puncture site markings, easy operation, less patient pain, puncture injury to the vertebral artery, pleural injury and less complications of brachial plexus nerve block, and quick effect on the head and face.
Third, the indications are currently considered that SGB has both peripheral and central effects.
The peripheral effect is to block the local sympathetic preganglionic or postganglionic fibers, so that the blood flow to the tissues and organs they innervate is significantly increased, and at the same time, a series of symptoms caused by sympathetic overexcitation is improved. Its central action is to improve the blood circulation of hypothalamus, regulate the function of hypothalamus and maintain the stability of the internal environment, while keeping the autonomic function, endocrine function and immune function of the body normal.
The indications for local action of SGB are to block all or part of the upper, middle and lower cervical sympathetic ganglia and their anterior and posterior fibers, thus blocking the vasomotor, glandular secretion (sweat glands, salivary glands, trachea, etc.), muscle tension, bronchoconstriction and nociceptive nerve fibers innervated by these sympathetic nerves, so that the tissues and organs of the guan, face, neck, shoulder, upper limbs, trachea, heart, lung and upper chest innervated by these sympathetic nerves are blocked due to sympathetic nerves. The changes in the tissues and organs of the upper chest caused by sympathetic overexcitation, such as circulatory disorders, pain hypersensitivity, and abnormal sweating, are corrected.
(a) Herpes zoster, reflex sympathetic dystrophy (phantom limb pain, amputation pain, burning pain), and hyperhidrosis of the head, neck, and upper chest.
1. Herpes zoster of the face, head and neck, upper extremities, and upper chest and back, i.e., herpes zoster above T3, is the best indication for SGB. Some people reported treatment, 25% pain elimination, and pain relief for 60% of PHN patients within 1 year.
2, reflex sympathetic dystrophy (RSD) This disease is closely related to abnormal sympathetic nerve function, so the administration of sympathetic nerve block is the best treatment for the upper front. sGB is suitable for the treatment of RSD of the upper extremities, face (such as caused by teeth).
3, hyperhidrosis symptoms hyperhidrosis is related to sympathetic nervous tension, so SGB can treat hyperhidrosis in its innervated area.
(B) Head diseases include migraine, tension-type headache, cluster headache, temporal arteritis, cerebral vascular spasm, cerebral thrombosis, and cerebral infarction. The treatment of vascular headache is mainly to improve the abnormal activity of blood vessels caused by vascular spasm or dilation to bring them to a stable state.
(C) Facial diseases terminal facial nerve palsy, Hunter syndrome, traumatic palsy, etc.; facial pain, such as atypical facial pain, masticatory muscle syndrome, jaw joint disease, trigeminal neuralgia, etc.
(iv) Eye diseases such as retinal vascular occlusive disease, retinitis pigmentosa, optic neuritis, macular edema after cataract extraction, corneal ulcers, etc. SGB can increase the blood supply to the eye and anti-inflammatory effect is effective.
(E) ENT diseases include sudden deafness, tinnitus, allergic rhinitis, and Meniere’s disease.
1.Sudden deafness
2.Tinnitus
3.Allergic rhinitis
(f) Neck scapular and upper extremity diseases where upper extremity pain is associated with reflex sympathetic excitation can be treated with SGB.
1, pain with irresolute disorders such as Raynaud’s disease, Raynaud’s syndrome, occlusive arterial disease, post-mastectomy syndrome, increased sweating, frostbite can be treated with SGB.
2.Pain in the upper shoulder limb that is not consistent with the distribution of the brachial plexus nerve 3.Pain in deep tissues such as joints, fluid membranes and pain-sensitive tissues and organs.
4.Nerve injury, inflammation, paralysis, and brachial plexus nerve entrapment neuropathy.
5. Pain accompanied by increased muscle tone, such as increased muscle tone from the neck to the arm and secondary stimulation of the nerve, causing circulatory disorders, further increasing muscle tone, forming a vicious circle, that is, the occurrence of neck-shoulder-arm syndrome.