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Randomized Controlled Trial
. 2020 Apr-Jun;23(2):170-176.
doi: 10.4103/aca.ACA_144_18.

Combined effect of left stellate ganglion blockade and topical administration of papaverine on left internal thoracic artery blood flow in patients undergoing coronary revascularization

Roshith Chandran  1 , Rupa Sreedhar  2 , Shrinivas Gadhinglajkar  2 , Prashantkumar Dash  2 , Jayakumar Karunakaran  3 , Vivek Pillai  3
Affiliations
Randomized Controlled Trial

Combined effect of left stellate ganglion blockade and topical administration of papaverine on left internal thoracic artery blood flow in patients undergoing coronary revascularization

Roshith Chandran et al. Ann Card Anaesth. 2020 Apr-Jun.

Abstract

Background: Left stellate ganglion blockade (LSGB) may have additive effect to topical administration of papaverine on prevention of vasospasm of left internal thoracic artery (LITA).

Aims: This study aims to compare LITA blood flow with topical application of papaverine alone or in combination with LSGB.

Setting: Tertiary care hospital.

Design: Prospective randomized controlled study.

Materials and methods: A total of 100 patients operated for coronary revascularization were randomly and equally allocated into two groups. In control Group-C, papaverine was applied topically during the dissection of LITA. In Group-S, the additional LSGB was performed. Blood flow was measured from cut end of the LITA for 15 s. Primary objectives of the evaluation were to observe differences in the LITA blood flow. Observing incidence of radial-femoral arterial pressure difference after cardiopulmonary bypass (CPB) was secondary objective.

Statistical analysis: Student's unpaired t-test and Fisher's exact test to find out a significant difference between the groups.

Results: LITA flow in Group-S was insignificantly more (49.28 ± 7.88 ml/min) than Group-C (47.12 ± 7.24 ml/min), (P = 0.15). Radio-femoral arterial pressure difference remained low for 40 min after termination of CPB in the Group-S compared to the Group-C (-0.99 ± 1.85 vs. -1.92 ± 2.26).

Conclusion: Combining LSGB with papaverine does not increase the LITA blood flow compared to when the papaverine is used alone. However, ganglion blockade reduces radial-femoral arterial pressure difference after CPB. Blockade can be achieved successfully under the ultrasound guidance without any complications.

Keywords: Cardiopulmonary bypass; coronary artery bypass grafting; femoral artery; internal thoracic artery; stellate ganglion block.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Figure demonstrates the ultrasonic image of stellate ganglion blockade. A 22G, 10 cm-long needle is directed towards the transverse process of the C6 vertebra, passing between the medial border of carotid artery and the lateral margins of the thyroid gland. The needle generates reverberation artefact during insertion. IJV: Internal jugular vein, CA: Carotid artery, TP: Transverse process of C6 vertebra, SCM: Sternocleidomastoid
Figure 2
Figure 2
Figure depicts pulse rate and radial-femoral arterial pressure difference against every 10 min time interval in the postcardiopulmonary bypass period. The mean pulse rate in both the groups is without any difference except at 30 min. The mean pressure difference between the left radial artery and femoral artery was negative in the postcardiopulmonary bypass period. The radio-femoral arterial pressure difference remained lower in the Group-S compared with Group-C, which remained statistically significant for first 40 min after weaning from cardiopulmonary bypass
See this image and copyright information in PMC

Comment in

  • In the Internal thoracic artery, more diameter does not always mean more flow.
    de la Cruz YL. de la Cruz YL. Ann Card Anaesth. 2021 Jan-Mar;24(1):125-126. doi: 10.4103/aca.ACA_118_20. Ann Card Anaesth. 2021. PMID: 33938857 Free PMC article. No abstract available.
  • In reply.
    Chandran R, Sreedhar R, Gadhinglajkar S, Dash PK, Karunakaran J, Pillai V. Chandran R, et al. Ann Card Anaesth. 2021 Jan-Mar;24(1):126-127. doi: 10.4103/aca.ACA_171_20. Ann Card Anaesth. 2021. PMID: 33938858 Free PMC article. No abstract available.

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