Abstract ID: A18

Abstract Title: Stellate Ganglion Block for the Treatment of Acute Postoperative Pain

Authors: Nassiri J¹, Julka I², McDonald J³
Harbor-UCLA Medical Center Torrance CA USA¹, Harbor-UCLA Medical Center Torrance CA USA², Harbor-UCLA Medical Center Torrance CA USA³
Poster Type: Either

ABSTRACT BODY

Introduction: A majority of cases resulting in complex regional pain syndrome (CRPS) occur after an orthopedic procedure1. Recently, Kakazu and Julka, reported the first case using a stellate ganglion block (SGB) for the treatment of acute post-operative pain2. Numerous publications in the literature support the use of SBG for sympathetically mediated pain. However, no study has examined its use in the acute postoperative setting. Thus, we performed a prospective study to examine the efficacy of SBG on acute postoperative pain.

Materials and Methods: Ten patients undergoing upper extremity orthopedic surgery were studied. All patients reported severe acute pain post-surgery despite treatment by conventional means (IV narcotics and NSAIDS). After informed consent, an ipsilateral SGB was performed using 10mL of 0.25% bupivacaine with a sterile technique. Patients’ vital signs, upper extremity temperature, pain scores, and sensory/motor exam were recorded at timed intervals.

Results:Pain Scores were measured on a visual analog scale (range 0-10). Cutaneous temperatures were measured by liquid crystallography. Values are represented in the table below.

Discussion: Overall, there was a significant improvement in pain relief (p<.0001). Temperature increase (p=<.0001) with the preservation of motor strength and two-point discrimination in all 10 patients confirms a sympathetic block, and rules out any somatic block component that could contribute to the pain relief. The success of the block in the absence of a CRPS history illustrates two important concepts namely: 1) an acute sympathetically mediated postoperative pain syndrome and/or 2) an acute postoperative CRPS. The challenge is to recognize the symptoms that differentiate post-surgical pain from acute sympathetic pain, albeit the close resemblance. It is highly probable that both sympathetic and somatic pain contribute to nocioceptive postoperative experience. We, however, demonstrated that by selectively blocking the sympathetic component greatly reduces patients’ postoperative pain perception.

ATTACHED FILES

A18_ASRA data file.doc

Reg Anesth Pain Med 2005; 30(3):A18