title: Stellate-ganglion block as a treatment for severe postmenopausal flushing.
abstract: OBJECTIVE
  Hormone replacement therapy is the most effective treatment for postmenopausal flushing. Unfortunately, its use is often contraindicated. A limited amount of uncontrolled data suggests that stellate-ganglion block (SGB) may be useful for the treatment of hot flushes. In the present study, we examined whether previously reported results could be reproduced in women with severe postmenopausal flushing.
  
  
  METHODS
  Twenty postmenopausal women with a baseline hot flush score ≥ 15  were treated with SGB in an open, uncontrolled setting. This mean daily hot flush score was calculated as the product of flush frequency and flush severity over a period of 1 week. The response to treatment was evaluated by flush scores and assessment of quality of life at baseline and 4 weeks after SGB.
  
  
  RESULTS
  The per-protocol analysis included 19 women. One woman was excluded because of lack of Horner syndrome after SGB. Four weeks after SGB, the mean flush score had decreased by 34 ± 7.4% (95% confidence interval (CI) 18-49%; p < 0.005). Nine women had a decrease in flush score between 40 and 90%, with a mean response of 65 ± 4.9% (95% CI 53-76%). The other ten women were non-responders with a decrease in flush score between 0 and 11%. Quality of life and sleep, both assessed by questionnaire, improved significantly.
  
  
  CONCLUSIONS
  The results of this study support the observation that SGB may be a useful therapy for a subset of women with severe postmenopausal flushing. A sham-controlled, single-blinded study is warranted to improve the evidence of efficacy.
authors.affiliation: Department of Internal Medicine Gynecology, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: van Gastel
authors.forename: J-W
authors.initials: JW
authors.lastname: Kallewaard
authors.forename: M
authors.initials: M
authors.lastname: van der Zanden
authors.forename: H
authors.initials: H
authors.lastname: de Boer
mesh_terms: D000704:Analysis of Variance; D000779:Anesthetics, Local; D001340:Autonomic Nerve Block; D016001:Confidence Intervals; D005260:Female; D019584:Hot Flashes / Q000628:therapy*; D006801:Humans; D008012:Lidocaine; D008875:Middle Aged; D017698:Postmenopause; D011788:Quality of Life; D012720:Severity of Illness Index; D012890:Sleep; D013233:Stellate Ganglion; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine