Differential effects of right versus left stellate ganglion block on left ventricular function in humans: an echocardiographic analysis.
OBJECTIVE
To evaluate the effects of unilateral stellate ganglion blockade on left ventricular function.


METHODS
Prospective cohort of patients with chronic regional pain syndrome type I and II of the upper extremity requiring therapeutic stellate ganglion blockade.


METHODS
University-affiliated hospital.


METHODS
Fifteen adult ASA physical status I and II patients with the diagnosis of chronic regional pain syndrome type I and II of the arm were studied. Right stellate ganglion block was performed in nine subjects and a left in six.


METHODS
Stellate ganglion block was performed with 10 mL of 1% plain Xylocaine. Transthoracic echocardiograms were performed immediately prior and 30 min following the block.


METHODS
Heart rate and blood pressure were monitored at regular intervals. Global systolic function was determined by calculating ejection fraction. Regional systolic motion was evaluated on the short axis and four-chamber views using the American Society of Echocardiography criteria. Diastolic function was assessed with pulsed-wave Doppler of the left ventricular outflow tract and the mitral valve. Data collected included isovolumic relaxation time and early and atrial velocity patterns.


RESULTS
A successful stellate ganglion block was achieved in all patients. Blood pressure and heart rate were not significantly different during data collection. Patients who underwent a right stellate ganglion block showed no significant differences in systolic or diastolic function. Following a left stellate ganglion block, global and regional systolic function remained unchanged. Isovolumic relaxation time was increased but did not reach statistical significance (80 +/- 13 ms to 88 +/- 9 ms; p = 0.09). Left ventricular end-diastolic (LVEDV) and end-systolic volumes (LVESV) were significantly increased (LVEDV from 73 +/- 9 mL to 100 +/- 9 mL, p < 0.02; LVESV from 31 +/- 4 mL to 37 +/- 4 mL, p < 0.03).


CONCLUSIONS
In patients without cardiovascular disease, unilateral denervation of the left ventricle after stellate ganglion block produces no clinical deleterious effects on left ventricular function.
Lobato
E B
EB
Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254, USA.
Kern
K B
KB
Paige
G B
GB
Brown
M
M
Sulek
C A
CA
D000328:Adult; D000779:Anesthetics, Local; D001794:Blood Pressure / Q000187:drug effects; D004452:Echocardiography; D005260:Female; D005730:Ganglionic Blockers / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008012:Lidocaine; D008297:Male; D009407:Nerve Block; D011446:Prospective Studies; D012019:Reflex Sympathetic Dystrophy / Q000188:drug therapy* / Q000503:physiopathology; D013233:Stellate Ganglion; D016277:Ventricular Function, Left / Q000187:drug effects*
D000779:Anesthetics, Local; D005730:Ganglionic Blockers; D008012:Lidocaine