Effects of Stellate Ganglion Block on Analgesia Produced by Cervical Paravertebral Block as Established by Quantitative Sensory Testing: A Randomized Controlled Trial

• Published in: Pain medicine (Malden, Mass.) Mass.), 2018-11, Vol.19 (11), p.2223-2235
• Main Authors: Sermeus, Luc A, Vanlinthout, Luc E, Hans, Guy H, Schepens, Tom, Breebaart, Margaretha B, Verheyen, Veerle C, Smitz, Carine J, Vercauteren, Marcel P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analgesia; Analgesics; Anesthesia; Anesthetics, Local - administration & dosage; Arthroscopy; Clinical trials; Double-Blind Method; Evidence-based medicine; Female; Ganglia; Health aspects; Humans; Male; Methods; Middle Aged; Pain Management; Pain perception; Pain, Postoperative; Patient outcomes; Patients; Physiological aspects; Prospective Studies; Shoulder; Stellate ganglion; Stellate Ganglion - drug effects; Surgery; Sympathetic nervous system; Sympathetic Nervous System - physiopathology
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pny004

Abstract Objective To use quantitative sensory testing (QST) to assess whether a stellate ganglion block (SGB) modulates the analgesia induced by cervical paravertebral block (CPVB). Design A prospective double-blind randomized controlled trial. Setting Department of Anesthesia, Antwerp University Hospital, October 2011 to December 2015. Subjects Twenty-eight adults scheduled for arthroscopy of a nonfractured shoulder were enrolled. Methods Participants were randomly assigned to receive either single CPVB (5 mL of levobupivacaine 0.5%) or combined CPVB + SGB (5 mL and 3 mL of levobubivacaine 0.5%, respectively). The detection thresholds for cold/warm sensations and cold/heat pain were established using thermal QST on the C4-C7 dermatomes before local anesthetic infiltration and at 0.5, 6, 10, and 24 hours thereafter. Our primary outcome was the time course of QST thresholds for the different neurosensitive/nociceptive modalities. As secondary and tertiary outcomes, we evaluated the degree of motor block and the time to first administration of rescue analgesics. Results We randomized 20 patients. There were no significant differences in the detection thresholds for the neurosensitive/nociceptive modalities, motor block, or timing for rescue analgesics between the groups (P = 0.15–0.94). All patients with CPVB + SGB exhibited Horner’s signs, whereas patients in the CPVB group did not exhibit these signs; however, this does not exclude sympathetic block. Conclusions We were unable to demonstrate any analgesic benefit of CPVB + SGB in arthroscopic shoulder surgery. It is therefore not unreasonable to suppose that pain from soft tissue injuries without bony lesions is transmitted mainly by somatic nerves with no or only minimal involvement of the sympathetic nervous system.