title: Comparison of different injectate volumes for stellate ganglion block: an anatomic and radiologic study.
abstract: BACKGROUND
  Volumes from 5 to 20 mL of local anesthetic are used for stellate ganglion block. The variation of practice gave us the impetus to investigate the distribution of 3 different volumes of solution. We documented the regions reached by each volume to assess the possibility to reduce the injectate to 5 mL.
  
  
  METHODS
  A total of 42 cadavers (84 halves), fixed by Thiel's method and on which pulse simulation was performed, were investigated. Of these 84 halves, 28 were injected with 5 mL of contrast (group A), 28 halves with 10 mL (group B), and 28 halves with 20 mL (group C), according to the tissue-displacement method. Immediately after injection, the cadavers were investigated by use of CT scans with a possible 3-dimensional reconstruction. In addition, 4 halves of group A and group B were dissected, and the contrast distribution was determined by photography.
  
  
  RESULTS
  Group A showed a constant dissemination from C4 to Th2-Th3, without spreading to ventral or lateral regions. In group B, a persistent spread from C4 to Th3 was documented. Ventral and lateral regions were also reached in one third of the specimens. Group C showed a constant dissemination from C3 to Th4-Th5, with additional spread to ventral, lateral, and posterior regions of the neck similar to that in group B.
  
  
  CONCLUSIONS
  The use of 5 mL results in an almost ideal vertical distribution in most of the cadavers, whereas high volumes--20 mL more so than 10 mL--are at risk of spreading extensively in both the vertical direction and also uncontrollably to other regions of the neck.
authors.affiliation: Department of Anatomy, Medical University Graz, Graz, Austria. georg.feigl@meduni-graz.at
authors.forename: Georg C
authors.initials: GC
authors.lastname: Feigl
authors.forename: Walter
authors.initials: W
authors.lastname: Rosmarin
authors.forename: Alfred
authors.initials: A
authors.lastname: Stelzl
authors.forename: Barbara
authors.initials: B
authors.lastname: Weninger
authors.forename: R
authors.initials: R
authors.lastname: Likar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001340:Autonomic Nerve Block / Q000009:adverse effects / Q000379:methods*; D002102:Cadaver; D003287:Contrast Media / Q000008:administration & dosage / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007267:Injections; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D013233:Stellate Ganglion / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D014018:Tissue Distribution; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media