Efficacy of ultrasonography guided stellate ganglion blockade in the stroke patients with complex regional pain syndrome

Abstract

Objective: To compare the efficacy of ultrasonography guided stellate ganglion block (US-SGB) with that of blind SGB in management of the stroke patients with complex regional pain syndrome (CRPS) type 1.

Method: Forty-two patients with post-stroke CRPS were randomly assigned to either US-guided SGB (22 patients) or blind SGB group (20 patients). The mean age of US-guided SGB and blind SGB groups was 61.3±5.6 years and 59.1±4.5 years. We performed two blockades at 7-day intervals on the affected side of patients with CRPS. Pain intensity, using a visual analog score (VAS), score of CRPS clinical severity, and the amounts of affected hand swelling with a hand volumeter were assessed before, 2 weeks and 4 weeks after treatment.

Results: In both groups, VAS and the amount of hand swelling were significantly decreased after 2 weeks and after 4 weeks. Between two groups, VAS difference of US-guided SGB group and that of blind SGB group were 2.61±1.09, 1.88±0.62 at 2 weeks and 3.67±1.03, 3.13±0.62 at 4 weeks, respectively. US-guided SGB group showed more significant improvement in mean change of VAS compared to the blind SGB group (p-value<0.05).

Conclusion: Both US-guided SGB and blind SGB techniques were effective in relieving pain in subacute stroke patients with CRPS. US-guided SGB was better in pain relief but has no advantages in reduction of hand swelling in this study.

Keywords: Complex regional pain syndrome; Stroke; Ultrasonography guided Stellate ganglion blockade.

Fig. 1

Ultrasonography imaging of the left stellate ganglion & prevertebral fascia (asterisks). Needle was advanced with real-time ultrasonography so that the needle tip will lie anterior to the longus coli. Th: Thyroid, LCo: Longus coli muscle, LCp: Longus capitus muscle, CA: Carotid artery, SCM: Sternocleidomastoid muscle, TP: Transverse process.