title: Evaluation of new approach to ultrasound guided stellate ganglion block.
abstract: BACKGROUND
  Ultrasound imaging is an ideal tool for stellate ganglion block (SGB) due to clarity, portability, lack of radiation, and low cost. Ultrasound guided anterior approach requires the application of pressure to the anterior neck and is associated with more risk of injury to inferior thyroid artery, vertebral artery, and esophagus. The lateral approach does not interfere with nerve or vascular structures. Blockade at the C6 vertebral level results in more successful sympathetic blockade of the head and neck with less sympathetic blockade of the upper extremity compared to sympathetic blockade at C7 vertebral level, which produces successful sympathetic blockade of upper extremity. This is helpful in patients of complex regional pain syndrome of the upper limb. Hence, we conducted a study using the lateral approach at C7 level.
  
  
  METHODS
  Ultrasound guided SGBs using lateral in-plane technique at C7 level were given in 20 patients suffering from chronic pain patients of upper extremity, head, and neck using 4 ml of 0.25% bupivacaine and 1 ml of 40 mg triamcinolone. The patients were assessed for a numeric pain intensity score (NPIS), the rise in axillary temperature, the range of motion of joints of upper extremity, and resolution of edema at various time intervals up to 3 months.
  
  
  RESULTS
  NPIS showed a statistically significant decrease from baseline at 30 min, which was sustained till 3(rd) month. The rise in axillary temperature after the block was statistically significant, which was sustained till 2(nd) week. The edema score decreased significantly at all-time intervals (P ≤ 0.001). The restriction of motion in all joints of upper limb decreased from 13 to 3 patients.
  
  
  CONCLUSIONS
  There is a significant variation in the anatomy of stellate ganglion at the level of C6 and C7. Ultrasound guided lateral approach increases the efficacy of SGB by deposition of drug subfascially with real-time imaging.
authors.affiliation: Department of Anesthesia and Critical Care, PGIMS, Rohtak, Haryana, India.
authors.forename: Anju
authors.initials: A
authors.lastname: Ghai
authors.affiliation: Department of Anesthesia and Critical Care, PGIMS, Rohtak, Haryana, India.
authors.forename: Teshi
authors.initials: T
authors.lastname: Kaushik
authors.affiliation: Department of Orthopedics, PGIMS, Rohtak, Haryana, India.
authors.forename: Zile Singh
authors.initials: ZS
authors.lastname: Kundu
authors.affiliation: MBBS student, PGIMS, Rohtak, Haryana, India.
authors.forename: Sarthak
authors.initials: S
authors.lastname: Wadhera
authors.affiliation: ENT, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India.
authors.forename: Raman
authors.initials: R
authors.lastname: Wadhera
keywords: Complex regional pain syndrome; lateral approach; stellate ganglion block; ultrasound guidance