[A possibility of central diffusion during stellate ganglion blockade: "the sheath of the spinal rachidian nerve"].
Stellate ganglion block is a common treatment for neuropathic pain. The technique is not without potentially severe complications when a paratracheal approach is used. A 33-year-old woman complained of atypical facial pain of 15 years' duration with pain intensity of 6 to 8 on a visual analog scale and no pain-free periods upon use of inadequate analgesia. One minute after performing a second stellate ganglion block the patient showed signs of apnea and paralysis of the upper extremities and face, with no involvement of oculomotor muscles or the lower extremities, and no loss of consciousness. Assisted ventilation was started. Signs and symptoms resolved fully after 15 minutes. A few days later, the patient reported having perceived paresthesia in the affected zone during the procedure. Central spread of a portion of local anesthetic by way of the spinal nerve sheath toward the subarachnoid space may cause partial cervical and basal nuclear blockade. Signs would be apnea, involvement of the upper extremities and facial muscles, although paresthesia during the injection is the only evidence supporting this hypothesis. Bone contact and negative aspiration while performing a stellate ganglion block do not guarantee avoidance of complications.
Soriano
C
C
Servicio de Anestesiología, Reanimación y Tratamiento del Dolor Hospital Germans Trias i Pujol, Badalona, Barcelona.
Ortiz
M
M
Fas
M J
MJ
Escudero
A
A
Roca
G
G
Vidal
F
F
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001049:Apnea / Q000139:chemically induced*; D001340:Autonomic Nerve Block / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D004058:Diffusion; D005158:Facial Paralysis / Q000139:chemically induced; D005260:Female; D006732:Horner Syndrome / Q000139:chemically induced*; D006801:Humans; D010148:Intractable Pain / Q000628:therapy*; D010243:Paralysis / Q000139:chemically induced*; D059348:Peripheral Nerve Injuries; D013126:Spinal Nerve Roots; D013233:Stellate Ganglion; D013346:Subarachnoid Space; D014277:Trigeminal Neuralgia / Q000628:therapy*
D000779:Anesthetics, Local; D002045:Bupivacaine