Treatment of patients with painful blind eye using stellate ganglion block

• Published in: Brazilian journal of anesthesiology (Elsevier) 2016-01, Vol.66 (1), p.75-77
• Main Authors: Xavier, Tatiana Vaz Horta, de Oliveira, Thiago Robis, Mendes, Tereza Cristina Bandeira Silva
• Format: Article
• Language: English
• Subjects: Amines - therapeutic use; Analgesics - therapeutic use; ANESTHESIOLOGY; Anesthetics, Local - administration & dosage; Autonomic Nerve Block - methods; Blindness - etiology; Bloqueio nervoso; Bupivacaine - administration & dosage; Cyclohexanecarboxylic Acids - therapeutic use; Dor ocular; Eye pain; Eye Pain - drug therapy; Eye Pain - etiology; Female; gamma-Aminobutyric Acid - therapeutic use; Glaucoma - complications; Humans; Manejo da dor; Nerve block; Pain management; Pain Measurement; Quality of Life; Stellate Ganglion; Treatment Outcome
• ISSN: 0104-0014; 1806-907X; 0104-0014
• DOI: 10.1016/j.bjane.2012.12.009

management of pain in painful blind eyes is still a challenge. Corticosteroids and hypotensive agents, as well as evisceration and enucleation, are some of the strategies employed so far that are not always effective and, depending on the strategy, cause a deep emotional shock to the patient. Given these issues, the aim of this case report is to demonstrate a new and viable option for the management of such pain by treating the painful blind eye with the stellate ganglion block technique, a procedure that has never been described in the literature for this purpose. six patients with painful blind eye, all caused by glaucoma, were treated; in these patients, VAS (visual analogue scale for pain assessment, in which 0 is the absence of pain and 10 is the worst pain ever experienced) ranged from 7 to 10. We opted for weekly sessions of stellate ganglion block with 4mL of bupivacaine (0.5%) without vasoconstrictor and clonidine 1mcg/kg. Four patients had excellent results at VAS, ranging between 0 and 3, and two remained asymptomatic (VAS=0), without the need for additional medication. The other two used gabapentin 300mg every 12h. currently, there are several therapeutic options for the treatment of painful blind eye, among which stand out the retrobulbar blocks with chlorpromazine, alcohol and phenol. However, an effective strategy with low rate of serious complications, which is non-mutilating and improves the quality of life of the patient, is essential. Then, stellate ganglion block arises as a demonstrably viable and promising option to meet this demand. O manejo da dor em olhos cegos dolorosos ainda é um desafio. Corticosteroides e hipotensores, bem como evisceração e enucleação, são algumas das estratégias até então empregadas, nem sempre eficazes e que, a depender da estratégia, causam um profundo abalo emocional no paciente. Dadas essas questões, o objetivo deste relato de caso é demonstrar uma nova e viável opção para o manejo desse tipo de dor por meio do tratamento do olho cego doloroso com bloqueios de gânglio cervicotorácico, técnica nunca descrita na literatura para esse fim. Foram tratados seis pacientes portadores de olho cego doloroso, todos por glaucoma, nos quais a EVA (escala visual analógica para avaliação da dor em que 0 é ausência de dor e 10 é a maior dor já experimentada) variava de 7 a 10. Optou-se por sessões semanais de bloqueio de gânglio cervicotorácico com 4 mL de bupivacaína (0,5%) sem vasoconstritor e clonidina 1 mcg/Kg. Quatr