| 1 Ultrasound-Guided Stellate Ganglion Block Performedby Inexperienced Residents: Accuracy and Safety[Objectives] To investigate the safety and accuracy of the ultrasound-imagedStellate ganglion block by an inexperience resident.[Methods] After the approval from the Institutional Review Boardconcerned, 20 patients (6 males, 14 females, aged 25-75 yr) who required thestellate ganglion block were recruited into this crossover study. The standardblind anterior paratracheal stellate ganglion block at the 6th cervicaltransverse process level (B-SGB) was performed on the 1st day; then, theultrasound-guided block (U-SGB) was performed ipsilaterally on the 3rd day,or vice versa performed on every one of the patients by the same residentwho was inexperienced in the stellate ganglion block (＜20 times). Thesuccess rate of the 1st attempt of the needle positioning, occurrence ofHomer's syndrome and unwanted effects were recorded.[results] When U-SGB was performed, the needle was accuratelypositioned at the 1st attempt, and the block was satisfactory without anyadverse effect in all the patients. On the other hand, when B-SGB was performed, the needle was accurately positioned at the 1st attempt in75%patients. Homer's syndrome appeared only in 60% patients. Unwanted effectssuch as hoarseness and pharyngeal foreign body sensation occurred in 35%patients.[conclusion]: The ultrasound imaging can improve the success rate and thesafety of the stellate ganglion block and it is helpful in the training of theresidents in the pain management.2 Influence of Needle Bevel Direction onUltrasound-Imaged Drug Spreading, Cervical VascularBlood Flow and Clinical Effect of Stellate Ganglion Block[Objectives] To investigate the Influence of needle bevel direction onultrasound-imaged drug spreading and clinical effect of steUate ganglionblock.[Methods] After the approval from the Institutional Review Boardconcerned, 20 patients (6 males, 14 females, aged 17-80 yr) who required thestellate ganglion block were recruited into this crossover study. On the firstday, the patients received the standard stellate ganglion block at the 6thcervical (C6) transverse process level with the needle bevel up or downdecided by the computer randomization. The ipsilateral block was repeatedon the third day only with the needle bevel opposite to that of the first time.The onset time of Homer's syndrome, the ultrasound-imaged blood flow ofthe vertebral artery and the internal carotid artery before the injection and 10 minutes after the injection, the ultrasound-imaged drug spreading rangereferred to the C6 transverse process were all recorded.[results] The onset time of Homer's syndrome was not significantlydifferent regardless of the needle bevel direction (P＞0.05). Referred to theC6 transverse process, the upper border and the lower border of the drugspreading were 3.21±0.43 cm and 2.23±0.47 cm, respectively with theneedle bevel upward, but 2.27±0.31 cm and 3.23±0.39 cm, respectivelywhen the needle bevel was downward directed. The drug spreading rangewas significantly different with the different needle bevel directions (P＜0.05). The blood flow of the vertebral artery and the internal carotid arterybefore the injection and 10 minutes after the injection was not significantlydifferent (P＞0.05).[Conclusion] During the stellate ganglion block, the local anesthetic isprone to spread in the direction to which the needle bevel is oriented.However, the needle bevel direction has no influence on the cervical vascularblood flow or the clinical effects of the stellate ganglion block.3 Influence of Posture on Ultrasound-Imaged DrugSpreading, Cervical Vascular Blood Flow and ClinicalEffect of Stellate Ganglion Block[Objectives] To investigate the influence of the patient's posture on theultrasound-imaged drug spreading, the cervical vascular blood flow, and theclinical effect of the stellate ganglion block (SGB). [Methods] After the approval from the Institutional Review Boardconcerned, 20 patients (8 males, 12 females, aged 17-67 yr) requiring thestellate ganglion block were recruited into this crossover study. All thepatients received the ipsilateral standard SGB twice. On the 1st day,immediately after the injection, the patients were kept supinationed or seatedin the position, which was decided by the computer randomization. On the 3rdday, after the 2nd injection, the patients were positioned just different to thefirst time. The onset time of Homer's syndrome, the ultrasound-imaged bloodflow of the vertebral artery and the internal carotid artery, the face skintemperature, the heart rate (HR), and the mean blood pressure (MBP) beforethe injection and 10 minutes after the injection, the ultrasound-imaged drugspreading range referred to the C6 transverse process were all recorded.[results] The onset time of Homer's syndrome was not significantly differentregardless of the patients' postures (P＞0.05). The face skin temperaturedifference before the injection and 10 min after the injection was 2.26±0.33℃when the patients kept supinated, which was not significantly different tothat (2.29±0.24℃) when the patients kept seated (P＞0.05). Referred to theC6 transverse process, the upper border and the lower border of the drugspreading were 3.49±0.35 cm and 1.98±0.57 cm, respectively when thepatients kept supinated, but 2.85±0.53 cm and 2.45±0.59 cm, respectivelywhen the patients kept seated. The drug spread downward more when thepatients in the seated position (P＜0.05). The blood flow of the vertebralartery and the internal carotid artery before the injection and 10 minutes afterthe injection was not significantly different (P＞0.05). Before the injection,the patients' HR, when the patients were supinated (HR, 75.30±11.97 beats/min), was not significantly different to that when they were seated(75.85±10.53 beats/min) (P＞0.05), and so were MBP (93.55±9.95 vs.94.9±8.54 mmHg). Ten minutes after the injection, both HR and MBPdecreased without any significant difference (HR, 73.30±8.46 beats/rain inthe supination vs. 71.20±7.91 beats/min in the seated position; MBP, 88.51±8.24 mmHg vs. 86.4±6.67 mmHg).[Conclusion] During the stellate ganglion block, the local anesthetic isprone to spread downward when the patients are in the seated position.However, the patients' postures have no influence on the patients' cervicalvascular blood flow or their clinical manifestation when they undergo thestellate ganglion block. |
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