Efficacy of stellate ganglion block with an adjuvant ketamine for peripheral vascular disease of the upper limbs

Kalpana R Kulkarni, Anita I Kadam, Ismile J Namazi, Kalpana R Kulkarni, Anita I Kadam, Ismile J Namazi

Abstract

Stellate ganglion block (STGB) is commonly indicated in painful conditions like reflex sympathetic dystrophy, malignancies of head and neck, Reynaud's disease and vascular insufficiency of the upper limbs. The sympathetic blockade helps to relieve pain and ischaemia. Diagnostic STGB is usually performed with local anaesthetics followed by therapeutic blockade with steroids, neurolytic agents or radiofrequency ablation of ganglion. There is increasing popularity and evidence for the use of adjuvants like opioid, clonidine and N Methyl d Aspartate (NMDA) receptor antagonist - ketamine - for the regional and neuroaxial blocks. The action of ketamine with sympatholytic block is through blockade of peripherally located NMDA receptors that are the target in the management of neuropathic pain, with the added benefit of counteracting the "wind-up" phenomena of chronic pain. We studied ketamine as an adjuvant to the local anaesthetic for STGB in 20 cases of peripheral vascular disease of upper limbs during the last 5 years at our institution. STGB was given for 2 days with 2 ml of 2% lignocaine + 8 ml of 0.25% bupivacaine, followed by block with the addition of 0.5 mg/kg of ketamine for three consecutive days. There was significant pain relief of longer duration with significant rise in hand temperature. We also observed complete healing of the gangrenous fingers in 17/19 patients.

Keywords: Ketamine; peripheral vascular disease; stellate ganglion block.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Technique of stellate ganglion block
Figure 2
Figure 2
Comparisons of the mean pre- and post-block VAS, temp. and duration of analgesia (h). Comparisons of the mean pre- and post-block PR/min and MBP on days 1 and 2 and days 3, 4 and 5 of STGB
Figure 3
Figure 3
Comparision of the mean VAS after STGB with LA vs addition with ketamine at 2, 6, 12, 16 and 24 h
Figure 4
Figure 4
Mean temperature changes in °C in mean of days 1 and 2 and days 3, 4 and 5 at 2, 6, 12, 16 and 24 h

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Source: PubMed

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