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Key points The sympathetic nervous system modulates cardiac contractile and electrophysiological function and contributes to adverse remodelling following myocardial infarction (MI). Axonal modulation therapy (AMT), directed at the sympathetic chain, blocks efferent sympathetic outflow to the heart and is a strategy to transiently and controllably mitigate chronic MI‐associated sympatho‐excitation. In porcine models, we evaluated scalable AMT, directed at the paravertebral chain, in blocking reflex‐mediated pacing‐induced sympatho‐excitation post‐MI. The level of sympatho‐excitation was assessed by dynamic interstitial measurement of noradrenaline (NA) and neuropeptide Y (NPY). In anaesthetized normal (n = 5) and age‐matched pigs 6 weeks post‐MI induction (n = 10), we electrically stimulated the right sympathetic chain and determined levels of direct current block applied at the T1–T2 level sufficient to reduce the evoked changes in heart rate and/or contractility by 25–75%. Reflex‐mediated neural release of NA and NPY into the interstitial space during programmed pacing (PP) was assessed using fast‐scanning cyclic voltammetry and capacitive immunoprobes. Normal animals demonstrated homogeneous NA and NPY release profiles during PP. In contrast, for MI animals PP evoked differential NA and NPY release in remote and MI border zones of the left ventricle. Right‐sided AMT mitigated NA and NPY pacing‐induced release in the remote left ventricle with a positive correlation to increasing AMT levels. Pacing‐induced NA and NPY release in the MI border zone was not mitigated by AMT. Differential effects of AMT on NA and NPY may underlie the anti‐arrhythmic effects of partial stellate ganglion block in the setting of chronic MI. Programmed cardiac pacing evokes homogeneous noradrenaline (NA) and neuropeptide Y (NPY) release in equivalent areas (e.g. medial and lateral aspects) of the normal left ventricle. Programmed cardiac pacing evokes differential NA and NPY release in remote and border zones of the infarcted left ventricle. Axonal modulation therapy (AMT), using a graded direct current block applied to the stellate ganglia, can proportionally modulate cardiac sympathetic reflexes. Unilateral AMT mitigates NA and NPY release in remote left ventricular tissue, with release negatively correlated to increasing AMT levels. Heterogeneities in NA and NPY between the border and remote tissues are reduced by progressive AMT. [ABSTRACT FROM AUTHOR]

A study was conducted to assess the impact of early anesthesia assessment on reducing MRI cancellations in pediatric patients at a children's hospital. The research found that timely evaluation may help decrease cancellations, highlighting the significance of prompt anesthesia management in pediatric care. Additionally, the study compared the effectiveness of ultrasound-guided suprazygomatic nerve block and greater palatine nerve block in children undergoing palatoplasty, with better pain scores and recovery in feeding ability observed in the suprazygomatic nerve block group. Further research is recommended to validate these findings. [Extracted from the article]

BACKGROUND: For decades, thousands of active-duty service members have sought treatment for trauma exposure. Stellate ganglion block (SGB) is a fast-acting nerve block documented in medical literature for nearly a century that has shown promise as a potentially life-altering treatment for post-traumatic stress (PTS). OBJECTIVE: This review aims to answer the practical questions of those who support individuals suffering from trauma: (1) SGB's safety profile (2) efficacy data (3) potential advantages and limitations, (4) a cross-cultural application example, (5) and the use of SGB in combination with talk therapy to optimize clinical outcomes. METHODS: The current body of literature, to include several large case series, meta-analyses, and a sufficiently powered randomized controlled trial, were reviewed, and presented to describe the history of SGB for emotional trauma symptoms and address the objectives of this review. RESULTS: Critical consideration is given to the safety and efficacy data on SGB and the evolution in safety-related technologies. Advantages such as decreased barriers to care, rapid onset, and decreased dropout and limitations such as treatment non-response, potential adverse effects, and misconceptions about the treatment are then described. Finally, the cross-cultural application of SGB is explored based on the deployment of SGB in Israel. CONCLUSION: SGB is associated with level 1B evidence and a reassuring safety profile. Evolving the model of care through the combined use of effective biological treatments like SGB with trauma informed talk therapy offers a hopeful path forward for supporting those who suffer from post-traumatic stress. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the study was to determine whether performing ultrasound-guided, bilateral stellate ganglion blocks (SGBs; performed on subsequent days) improved traumatic brain injury (TBI) symptoms. Methods A retrospective chart review was conducted for the time period between August 2022 and February 2023 to identify patients who received bilateral, 2-level (C6 and C4) SGBs for PTSD symptoms but who also had a history of TBI. Neurobehavioral Symptoms Inventory (NSI) scores were collected at baseline, 1 week, and 1 month post-treatment in 14 males and 9 females. Results Out of 23 patients, 22 showed improvement in their NSI scores. NSI baseline average score was 42.7; the average score at 1 week post-treatment was 18.8; 1 month post-treatment was 20.1. This represents a 53% improvement in the NSI score between baseline and 1 month. Conclusion The use of bilateral, 2-level SGBs may be indicated in treating patients with PTSD symptoms with concomitant diagnoses of mild-to-moderate TBI. [ABSTRACT FROM AUTHOR]

Purpose of Review: To explore the mechanism and therapeutic effect of sympathetic nerve regulation on neuropathic pain. Recent Findings: A comprehensive search was conducted in the PubMed and CNKI libraries, using the following keywords: stele ganglion block, neuropathic pain, sympathetic nerve block, sympathetic chemical destruction, and sympathetic radiofrequency thermocoagulation. We selected and critically reviewed research articles published in English that were related to sympathetic modulation in the treatment of neuropathic pain. The collected literature will be classified according to content and reviewed in combination with experimental results and clinical cases. Neuropathic pain was effectively treated with sympathetic regulation technology. Its mechanism includes the inhibition of sympathetic nerve activity, regulation of the inflammatory response, and inhibition of pain transmission, which greatly alleviates neuropathic pain in patients. Stellate ganglion blocks, thoracic and lumbar sympathectomies, chemical destruction, and radiofrequency thermocoagulation have been widely used to treat neuropathic pain. Summary: Sympathetic regulation can effectively relieve pain symptoms and improve the patient's quality of life by inhibiting sympathetic nerve activity, reducing the production and release of pain-related mediators, and inhibiting pain transmission. CT-guided radiofrequency thermocoagulation of the thoracic and lumbar sympathetic nerves is effective and durable, with few complications, and is recommended as a treatment for intractable neuropathic pain. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of ultrasound-guided stellate ganglion block (U-SGB) combined with ultrasound-guided serratus anterior plane block (U-SAPB) on postoperative acute pain and sleep duration in patients undergoing radical mastectomy. Methods: 120 female patients who underwent radical mastectomy were randomly divided into the control group, the U-SAPB group and the combined group (U-SGB combined with U-SAPB), with 40 cases in each group. Patients of the control group received only general anesthesia, patients of the U-SAPB group received U-SAPB, and patients of the combined group received U-SGB and U-SAPB. All patients were given patient-controlled intravenous analgesia (PCIA) after surgery. The visual analogue scale (VAS) of pain intensity, the duration of nocturnal sleep, the time of first pressing the analgesic pump and the number of effective presses were compared among the three groups at different time points after surgery. Results: Compared with the control group, the VAS scores of the combined group were significantly lower at all time points after surgery (P<0.05), the time of first pressing the analgesic pump was significantly delayed, the number of effective presses of the analgesic pump was reduced, and the duration of nocturnal sleep was longer within 3 days after surgery (P<0.05); compared with the U-SAPB group, the VAS scores of the combined group were better at 8 h and later after surgery, and the time of first pressing the analgesic pump was later (P<0.05). Conclusion: Compared with simple general anesthesia and serratus anterior plane block, ultrasound-guided stellate ganglion block combined with serratus anterior plane block can effectively alleviate postoperative acute pain in breast cancer patients, prolong the duration of early nocturnal sleep. [ABSTRACT FROM AUTHOR]

Introduction: Cardiogenic shock is severe circulatory failure that results in significant in-hospital mortality, related morbidity, and economic burden. Patients with cardiogenic shock are at high risk for atrial and ventricular arrhythmias, particularly within the subset of patients with an overlap of cardiogenic shock and cardiac arrest. Areas covered: This review article will explore the prevalence, definition, management, and outcomes of common arrhythmias in patients with cardiogenic shock. This review will describe the pathophysiology of arrhythmia in cardiogenic shock and the impact of inotropic agents on increased arrhythmogenicity. In addition to medical management, focused assessment of mechanical circulatory support, radiofrequency ablation, deep sedation, and stellate ganglion block will be provided. Expert opinion: We will navigate the limited data and describe the prognostic impacts of arrhythmia. Finally, we will conclude the review with a discussion of prevention strategies, research limitations, and future research directions. [ABSTRACT FROM AUTHOR]

The cardiac autonomic nervous system plays a key role in maintaining normal cardiac physiology, and once disrupted, it worsens the cardiac disease states. Neuromodulation therapies have been emerging as new treatment options, and various techniques have been introduced to mitigate autonomic nervous imbalances to help cardiac patients with their disease conditions and symptoms. In this review article, we discuss various neuromodulation techniques used in clinical settings to treat cardiac diseases. [ABSTRACT FROM AUTHOR]

Abstract Electrical storm (ES) is a life-threatening condition of recurrent ventricular arrhythmias (VA) in a short period of time. Percutaneous stellate ganglion blockade (SGB) is frequently used – however the efficacy is undefined. The objective of our systematic review was to determine the efficacy of SGB in reducing VA events and mortality among patients with ES. A search of Medline, EMBASE, Scopus, CINAHL and CENTRAL was performed on February 29, 2024 to include studies with adult patients (≥ 18 years) with ES treated with SGB. Our outcomes of interest were VA burden pre- and post-SGB, and in-hospital/30-day mortality. A total of 553 ES episodes in 542 patients from 15 observational studies were included. Treated VAs pre- and post-SGB were pooled from eight studies including 383 patients and demonstrated a decrease from 3.5 (IQR 2.25–7.25) to 0 (IQR 0–0) events (p = 0.008). Complete resolution after SGB occurred in 190 of 294 patients (64.6%). Despite this, in-hospital or 30-day mortality remained high occurring in 140 of 527 patients (random effects prevalence 22%). Repeat SGB for recurrent VAs was performed in 132 of 490 patients (random effects prevalence 21%). In conclusion, observational data suggests SGB may be effective in reducing VAs in ES. Definitive studies for SGB in VA management are needed. Study protocol: PROSPERO - registration number CRD42023430031.

Background: To explore the effect of right stellate ganglion block (RSGB) during laparoscopic cholecystectomy (LC) for control of intraoperative arrhythmia during CO2 pneumoperitoneum and postoperative pain relief Methods: Forty patients undergoing LC in our hospital were selected as the subjects and were randomly divided into group S (20 cases) and group C (20 cases), all patients received RSGB, 10 mL of lidocaine 2% under ultrasound guidance to compare the incidence of arrhythmia (1ry outcome), changes of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MBP) in different time points and postoperative visual analogue scale (VAS) was reported in the 1st, 6th, and 12th hours, respectively, with time to first analgesia request. Results: Intraoperative arrhythmias was significantly lower in group S rather than group C (P = 0.037); postoperative pain profile revealed that there was a significant difference between the 2 groups presented as longer duration for first time to request analgesia (P = 0.015) and lower VAS scores specially at the 1st and 6th postoperative hours in group S compared to group C (P < 0.001 and 0.004); changes in heart rate and blood pressure, there was a significant difference between the 2 groups in values of both parameters 5 minutes following CO2 insufflation, group S showed significantly lower HR, SBP, and MBP at this time point than group C. Conclusion: Patients received RSGB before laparoscopic cholecystectomy can experience lower incidence of arrhythmia, better intraoperative hemodynamics, and effective pain control postoperatively. [ABSTRACT FROM AUTHOR]

Abstract Cerebral vasospasm is determined as a temporary narrowing of cerebral arteries a few days after an aneurysmal subarachnoid hemorrhage. The onset of this vascular event usually evolves with new neurological deficits or progression of ischemic areas. The success of interventions to treat or revert this condition is not satisfying. In addition to cerebral vasospasm, early brain injury plays an important role as a contributor to subarachnoid hemorrhage’s mortality. In this sense, stellate ganglion block appears as an alternative to reduce sympathetic system’s activation, one of the main pathophysiological mechanisms involved in brain injury. Over the past few years, there is growing evidence that stellate ganglion block can contribute to decline patient morbidity from subarachnoid hemorrhage. Is it time to include this procedure as a standard treatment after aneurysm rupture?

Yayun Gan,1 Jian Chen,1 Lini Xian,2 Yuan Shi2 1Department of Ultrasound, The First Hospital of Kunming City, The Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, 650011, People’s Republic of China; 2Department of Ultrasound, Yanan Hospital of Kunming City, The Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, 650051, People’s Republic of ChinaCorrespondence: Jian Chen, The First Hospital of Kunming City, The Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, 650011, People’s Republic of China, Email chenjian6@kmmu.edu.cnPurpose: Emerging evidence suggests that although Horner’s syndrome manifests observable facial changes, it may not comprehensively evaluate the hemodynamic alterations associated with stellate ganglion block (SGB). This study endeavors to systematically evaluate the influence of SGB on the elasticity and flow velocity of the common carotid artery (CCA) and brachial artery utilizing ultrasound wave intensity analysis (usWIA). Particularly, it focuses on patients necessitating monitoring for its effects on specific organs or regions.Methods: Totally, we selected 33 patients, where only 31 patients (comprising 15 males and 16 females) were included between September 2020 to January 2022 after screening patients who require SGB treatment for painful disorders. The side on which the SGB was administered depended on the patient’s painful side, 13 cases underwent left stellate ganglion block (LSGB), and 18 cases underwent right stellate ganglion block (RSGB). Wave intensity (WI) data were collected by usWIA on the CCA and brachial artery before the administration of SGB and after the manifestation of Horner’s syndrome. We then compared the changes in these data pre- and post-SGB using SPSS 26.0.Results: The results showed an increase in arterial compliance (AC) of the CCA and brachial artery on the blocked side after SGB (P < 0.05). In contrast, pressure-strain elastic modulus (EP) and arterial stiffness pulse wave velocity (PWVβ) decreased (for all P < 0.05). Furthermore, the minimum velocity (Vmin) of the CCA exhibited a significant increase (P < 0.01), while wave intensity pulse wave velocity (PWVwi) was significantly reduced (P < 0.01). In contrast, on the contralateral side of the CCA, EP and PWVβ increased after SGB (for all P < 0.05), while AC decreased (P < 0.05).Conclusion: SGB has been observed to enhance the elasticity and blood flow velocity of arteries within its innervated areas. In clinical practice, usWIA can serve as an objective measurement tool for assessing the impact of SGB on arterial elasticity and flow velocity in specific organs or regions. Furthermore, unilateral SGB has been noted to diminish the arterial elasticity of the CCA on the contralateral side.The plain language summary: Question: How to accurately and objectively evaluate the hemodynamic changes of SGB on targeted organs or regions?Findings: SGB increased the elasticity and blood flow velocity of the arteries on the blocked side by usWIA.Meaning: The usWIA could serve as an objective measurement tool for assessing the effects of SGB on arterial elasticity and blood flow velocity, especially for patients needing evaluation of its impact on the upper limbs.Keywords: ultrasound wave intensity analysis, stellate ganglion block, hemodynamics, arterial elasticity

Complex regional pain syndrome (CRPS) is a multifaceted condition characterized by chronic neuropathic pain, allodynia, and hyperalgesia. The incidence of CRPS postoperatively is alarmingly high, particularly following carpal tunnel surgeries, Dupuytren's fasciectomy, and repairs of wrist and hand fractures, with recurrence rates soaring in individuals with a history of CRPS. Despite extensive research, the management of CRPS remains complicated, highlighting the urgent need for effective prevention strategies. This scoping review aimed to consolidate current evidence surrounding the efficacy of perioperative anesthetic techniques in preventing new-onset or recurrent CRPS, focusing on the application of various anesthetic interventions. Through a comprehensive literature search, eight articles were identified, discussing a spectrum of techniques, including wide awake local anesthesia no tourniquet (WALANT) and various regional blockade methods. This review revealed that the WALANT technique, with its simplicity and lower costs, exhibited promising results in preventing CRPS. Conversely, techniques involving intravenous regional and axillary plexus blocks showed variable efficacy, necessitating further investigation. The scarcity of high-quality evidence underscores the critical need for meticulously designed, large-scale randomized controlled trials to validate these findings and explore the potential of stellate ganglion block in the prevention of recurrent CRPS. [ABSTRACT FROM AUTHOR]

• High-voltage long-duration pulsed radiofrequency has more obvious analgesic effect than standard voltage pulsed radiofrequency. • High-voltage long-duration pulsed radiofrequency combined with stellate ganglion block has more advantages in improving sleep and anxiety in patients with acute herpes zoster neuralgia. • Dual guidance of ultrasound and C-arm represents a safe, effective, environmentally friendly, and cost-efficient method for treating acute herpes zoster neuralgia, and it suitable for community hospitals to carry out. A single therapeutic approach is not always successful in the treatment of herpes zoster neuralgia, and the appropriate combination of different treatments deserves further exploration. In this study, we investigated the clinical efficacy of high-voltage long-duration pulsed radiofrequency (PRF) combined with stellate ganglion block (SGB) in the acute phase of thoracic and dorsal herpes zoster neuralgia under dual guidance of ultrasound and C-arm. 79 cases of acute zoster neuralgia were grouped premised upon differing therapeutic approaches: standard voltage PRF (group S, the temperature, duration, pulse width, frequency and voltage were set to 42 °C, 300 s, 20 ms, 2 Hz, and 45 V), high-voltage long-duration PRF (group H, parameters of PRF were set to 42 °C, 900 s, 20 ms, 2 Hz, and 90 V, respectively), and high-voltage long-duration PRF combined with SGB (group C, parameter settings for PRF are the same as those for group H). The therapeutic outcomes were assessed utilizing the numeric rating scale (NRS), Pittsburgh sleep quality index (PSQI), and Hamilton anxiety rating scale (HAMA). The incidence of clinically significant postherpetic neuralgia post-treatment had been documented. Compared to baseline, scores of NRS, PSQI, and HAMA at each time point post-treatment decreased across all groups, and the decrease was more significant in the C group than in the S group. At the later stage of treatment, the consumption of pregabalin and tramadol and the plasma levels of interleukin-6 and galectin-3 in the C group were significantly lower than those in the S group. The incidence of PHN in the C group was significantly lower than in the S group. The combination of high-voltage long-duration PRF combined with SGB under dual guidance of ultrasound and C-arm represents a safe, effective, environmentally friendly, and cost-efficient method for treating AZN, significantly improving sleep quality, alleviating anxiety, and reducing the risk of PHN occurrence. [ABSTRACT FROM AUTHOR]

Cerebral vasospasm is determined as a temporary narrowing of cerebral arteries a few days after an aneurysmal subarachnoid hemorrhage. The onset of this vascular event usually evolves with new neurological deficits or progression of ischemic areas. The success of interventions to treat or revert this condition is not satisfying. In addition to cerebral vasospasm, early brain injury plays an important role as a contributor to subarachnoid hemorrhage's mortality. In this sense, stellate ganglion block appears as an alternative to reduce sympathetic system's activation, one of the main pathophysiological mechanisms involved in brain injury. Over the past few years, there is growing evidence that stellate ganglion block can contribute to decline patient morbidity from subarachnoid hemorrhage. Is it time to include this procedure as a standard treatment after aneurysm rupture? [ABSTRACT FROM AUTHOR]

Introduction: When electrical storm (ES) is amenable to neither antiarrhythmic drugs, nor deep sedation or catheter ablation, autonomic modulation may be considered. We report our experience with percutaneous left stellate ganglion block (PSGB) to temporarily suppress refractory ventricular arrhythmia (VA) in patients with structural heart disease. Methods: A retrospective analysis was performed at our institution of patients with structural heart disease and an implantable cardioverter defibrillator (ICD) who had undergone PSGB for refractory VA between January 2018 and October 2021. The number of times antitachycardia pacing (ATP) was delivered and the number of ICD shocks/external cardioversions performed in the week before and after PSGB were evaluated. Charts were checked for potential complications. Results: Twelve patients were identified who underwent a combined total of 15 PSGB and 5 surgical left cardiac sympathetic denervation procedures. Mean age was 73 ± 5.8 years and all patients were male. Nine of 12 (75%) had ischaemic cardiomyopathy, with the remainder having non-ischaemic dilated cardiomyopathy. Mean left ventricular ejection fraction was 35% (± 12.2%). Eight of 12 (66.7%) patients were already being treated with both amiodarone and beta-blockers. The reduction in ATP did not reach statistical significance (p = 0.066); however, ICD shocks (p = 0.028) and ATP/shocks combined were significantly reduced (p = 0.04). At our follow-up electrophysiology meetings PSGB was deemed ineffective in 4 of 12 patients (33%). Temporary anisocoria was seen in 2 of 12 (17%) patients, and temporary hypotension and hoarseness were reported in a single patient. Discussion: In this limited series, PSGB showed promise as a method for temporarily stabilising refractory VA and ES in a cohort of male patients with structural heart disease. The side effects observed were mild and temporary. [ABSTRACT FROM AUTHOR]

Background Cardiac sarcoidosis (CS) is a granulomatous disease that can manifest as conduction defects, ventricular arrhythmias, and heart failure. The diagnosis of CS is inherently difficult due to variable presentations; as such, endomyocardial biopsy is often required but lacks sensitivity due to patchy myocardial involvement. Moreover, the diagnostic criteria of CS and arrhythmogenic cardiomyopathy overlap, particularly in right-side dominant or biventricular presentations, which further complicates an already challenging differential diagnosis. Case summary A 53-year-old man with no prior chronic medical conditions presented with ventricular tachycardia (VT) and heart failure with reduced ejection fraction. He was found to have biventricular cardiomyopathy and late gadolinium enhancement on cardiac magnetic resonance imaging, resulting in an initial diagnosis of arrhythmogenic cardiomyopathy. Implantable cardioverter-defibrillator was placed, but he was readmitted for recurrent VT 2 months later. Despite an aggressive VT therapy (combination of antiarrhythmic drugs, epicardial and endocardial ablation, and stellate ganglion block), he continued with refractory VT and developed cardiogenic shock. Extra-corporeal membrane oxygenation was initiated as a bridge to heart transplantation. Pathology of the explanted heart revealed the underlying disease to be CS. Discussion Cardiac sarcoidosis can mimic arrhythmogenic biventricular cardiomyopathy and may be difficult to distinguish by the proposed diagnostic criteria. High clinical suspicion and thorough investigation are necessary for an earlier diagnosis and initiation of treatment. [ABSTRACT FROM AUTHOR]

To explore the feasibility of stellate ganglion block (SGB) for the treatment of brain injury and the inhibitory effect of neuronal apoptosis. SD rats were randomly divided into control group, model group (LPS 0.6 mg/kg), and SGB group (LPS 0.6 mg/kg + lidocaine 0.2 mL). The rats were sacrificed after SGB block for 2 h to separate the hippocampus. The pathological changes of hippocampal tissue were observed by HE staining, the apoptosis of hippocampal neurons was observed by TUNEL staining, the positive expression of B-cell lymphoma-2-Associated X (Bax) in hippocampal tissue was detected by immunohistochemistry, and the expression of Bax mRNA in hippocampal tissue was detected by qRT-PCR method. Results: Compared with the control group, the hippocampal tissue of the model group was severely damaged, and the apoptosis rate of hippocampal neurons, the positive rate of Bax protein, the expression of Bax mRNA, and the protein expressions of Baxwere significantly increased, the protein expression of Bcl-2 was significantly decreased (P < 0.05).Compared with the model group, the hippocampal tissue damage of the SGB group was significantly reduced, and the hippocampal neuron apoptosis rate, Bax protein positive rate, Bax mRNA expression and Bax protein expressions were significantly decreased, and the expression of Bcl-2 protein was significantly increased (P < 0.05). Conclusion: SGB can reduce the apoptosis of neurons in rats and improve brain injury by inhibiting the expression of Bax gene. [ABSTRACT FROM AUTHOR]

This article explores the use of stellate ganglion block (SGB) as a potential treatment for SAPHO syndrome, a rare and challenging inflammatory disease that affects the bones and skin. The study presents a case where SGB successfully alleviated symptoms and prevented disease progression in a patient with SAPHO syndrome. SGB, which blocks sympathetic nerves and improves immune function, has been used to treat other chronic pain and inflammatory conditions. The article suggests that SGB may be a promising treatment option for SAPHO syndrome and calls for more research in this area. [Extracted from the article]

This article from the European Heart Journal focuses on several topics in cardiovascular medicine. It includes a debate on whether SGLT2 inhibitors should be the first-line treatment for heart failure with reduced ejection fraction, as well as discussions on cardio-oncology, the association between atrial fibrillation and cancer, platelet-fibrin clot strength and platelet reactivity in patients undergoing percutaneous coronary intervention, and the role of IL-1α in chemotherapy-related cardiotoxicity. The article also explores the use of cardiac biomarkers for diagnosing Takotsubo syndrome and the presence of atherosclerosis in ancient mummified humans. The authors provide insights and perspectives on these topics, highlighting the need for further research and personalized approaches to cardiovascular care. [Extracted from the article]

Postoperative cognitive dysfunction (POCD) is a common complication affecting elderly patients after anaesthesia. It is characterised by acute or persistent impairments of attention, learning and memory after surgery. This cognitive disorder can lead not only to an increase in postoperative complications and prolonged hospital stays, but also to an increased societal burden and waste of medical resources. Stellate ganglion block (SGB) is a commonly used nerve block technique in clinical practice. It works to block neural signals from stellate ganglion to control pain or treat certain conditions primarily by injecting local anaesthetics. This article summarises the mechanisms by which SGB improves POCD, focusing on the regulation of cerebral vasculature, oxidative stress and inflammatory responses. It aims to provide elderly patients with an approach to safer and more effective postoperative recovery and seek new therapies to alleviate the burden of POCD. [ABSTRACT FROM AUTHOR]

Background: Post‐COVID parosmia may be due to dysautonomia and sympathetic hyperresponsiveness, which can be attenuated by stellate ganglion block (SGB). This study evaluates SGB as a treatment for post‐COVID olfactory dysfunction (OD). Methods: Retrospective case series with prospective data of patients with post‐COVID OD undergoing unilateral (UL) or bilateral (BL) SGB. Patients completed Brief Smell Identification Tests (BSIT) (12 points maximum) and post‐procedure surveys including parosmia severity scores on a scale of 1 (absent) to 10 (severe). Scores were compared from before treatment (pre‐SGB) to after first (SGB1) or second (SGB2) treatments in overall, UL, and BL cohorts. Results: Forty‐seven patients with post‐COVID OD underwent SGB, including 23 UL and 24 BL. Twenty patients completed pre‐ and post‐SGB BSITs (eight UL and 12 BL). Twenty‐eight patients completed postprocedure surveys (11 UL and 17 BL). There were no differences in BSIT scores from pre‐SGB to post‐SGB1 or post‐SGB2 for the overall (p = 0.098), UL (p = 0.168), or BL (p = 0.230) cohorts. Parosmia severity for the overall cohort improved from pre‐SGB (8.82 ± 1.28) to post‐SGB1 (6.79 ± 2.38) and post‐SGB2 (5.41 ± 2.35), with significant differences from pre‐SGB to post‐SGB1 (p < 0.001) and pre‐SGB to post‐SGB2 (p < 0.001), but not post‐SGB1 to post‐SGB2 (p = 0.130). Number of parosmia triggers decreased for overall (p = 0.002), UL (p = 0.030) and BL (p = 0.024) cohorts. Quality of life (QOL) improved for all cohorts regarding food enjoyment, meal preparation, and socialization (p < 0.05). Conclusion: SGB may improve subjective parosmia and QOL for patients with post‐COVID OD, however it may not affect odor identification. Further placebo‐controlled studies are warranted. [ABSTRACT FROM AUTHOR]

Stellate ganglion blocks (SGBs) has been applied in clinics to alleviate pain-related syndromes for almost a century. In recent years, it has been reported that SGB can attenuate acute lung injury (ALI) in animals. However, the details of these molecular mechanisms remain complex and unclear. In this study, rats were randomly divided into four groups: group C (receiving no treatment), group NS (receiving the intratracheal instillation of normal saline), group L (receiving the intratracheal instillation of LPS) and group LS (receiving SGB after the intratracheal instillation of LPS). The pathological damage of lung tissue, arterial blood gases, the differentiation of alveolar macrophages (AMs) and inflammatory cytokines (IL-1β, IL-6, IL-10) were detected. Furthermore, the oxidative stress indexes (ROS, CYP-D, T-SOD, Mn-SOD and CAT) in serum and the levels of Sirt3 signaling-associated proteins (JAK2/STAT3, NF-κb p65, CIRP and NLRP3) in the lungs were measured. The results revealed that SGB could attenuate lung tissue damage, improve pulmonary oxygenation, promote the differentiation of AMs to the M2 phenotype, decrease the secretion of IL-1β and IL-6, and increase the secretion of IL-10. Meanwhile, SGB was found to inhibit the production of ROS and CYP-D, and enhance the activities of T-SOD, Mn-SOD and CAT. Furthermore, SGB upregulated Sirt3 and downregulated JAK2/STAT3 and NF-κb p65 phosphorylation, CIRP and NLRP3. Our work revealed that SGB could attenuate LPS-induced ALI by activating the Sirt3-mediated regulation of oxidative stress and pulmonary inflammation; this may shed new light upon the protection of SGB and provide a novel prophylactic strategy for LPS-induced ALI. [ABSTRACT FROM AUTHOR]

Sympathetic overactivity is a recognized underlying mechanism contributing to the pathogenesis of ventricular electrical storm (VES). The growing body of evidence supports the efficacy of stellate ganglion block (SGB) in attenuating myocardial sympathetic tone, rendering it a valuable adjunctive therapy for managing VES. This case report presents the clinical details of a 60-year-old patient admitted for ventricular tachycardia (VT), necessitating the implantation of an implantable cardioverter defibrillator (ICD) to mitigate the risk of fatal ventricular arrhythmias (VAs). Subsequently, the patient received repeated antitachycardia pacing (ATP) therapy due to persistent symptomatic VT episodes. SGB was contemplated due to the patient's hemodynamic instability during episodes of VT and the ineffectiveness of pharmacotherapy. Initially, complete suppression of VT was achieved for 3 days using local anesthesia, followed by partial suppression via pulsed radiofrequency (PRF), culminating in sustained relief for 3 months following continuous radiofrequency (CRF) therapy. Different methods of SGB elicited varied responses in this patient. CRF appeared to be more effective than PRF and conventional local anesthetics. CRF ablation of the stellate ganglion for refractory VAs offers a potential therapeutic option.

Abstract Background With the increasing prevalence of colorectal cancer (CRC), optimizing perioperative management is of paramount importance. This study investigates the potential of stellate ganglion block (SGB), known for its stress response-mediating effects, in improving postoperative recovery. We postulate that preoperative SGB may enhance the postoperative recovery of patients undergoing laparoscopic CRC surgery. Methods We conducted a randomized controlled trial of 57 patients undergoing laparoscopic colorectal cancer surgery at a single center. Patients, aged 18–70 years, were randomly assigned to receive either preoperative SGB or standard care. SGB group patients received 10 mL of 0.2% ropivacaine under ultrasound guidance prior to surgery. Primary outcome was time to flatus, with secondary outcomes encompassing time to defecation, lying in bed time, visual analog scale (VAS) pain score, hospital stays, patient costs, intraoperative and postoperative complications, and 3-year mortality. A per-protocol analysis was used. Results Twenty-nine patients in the SGB group and 28 patients in the control group were analyzed. The SGB group exhibited a significantly shorter time to flatus (mean [SD] hour, 20.52 [9.18] vs. 27.93 [11.69]; p = 0.012), accompanied by decreased plasma cortisol levels (mean [SD], postoperatively, 4.01 [3.42] vs 7.75 [3.13], p = 0.02). Notably, postoperative pain was effectively managed, evident by lower VAS scores at 6 h post-surgery in SGB-treated patients (mean [SD], 4.70 [0.91] vs 5.35 [1.32]; p = 0.040). Furthermore, patients in the SGB group experienced reduced hospital stay length (mean [SD], day, 6.61 [1.57] vs 8.72 [5.13], p = 0.042). Conclusions Preoperative SGB emerges as a promising approach to enhance the postoperative recovery of patients undergoing laparoscopic CRC surgery. Clinical trial registration ChiCTR1900028404, Principal investigator: Xia Feng, Date of registration: 12/20/2019.

Abstract Background There have been no reports on the successful implementation of stellate ganglion block (SGB) in mice. Objectives This study aims to investigate a new method for implementing SGB in mice by placing them in a supine position with abducted upper limbs and touching the trachea and sternoclavicular joint with the hand. Methods Fifty BABL/C mice, 8–10 weeks, were selected and randomly divided into four groups: control group (n = 5); SGB-R group (n = 15); SGB-L group (n = 15); and SGB-L + R (group n = 15). SGB was administered with 0.15% ropivacaine solution in a volume of 0.1 mL. The control group received equal volumes of saline. Horner's syndrome, heart rate, and complications such as brachial plexus block, vascular injury, pneumothorax, local anesthetic toxicity, and death were observed. Results Horner's syndrome developed in 100% of SGB surviving mice; no difference was seen in the time to onset (100.4 ± 13.4 vs 96.7 ± 12.4, mean ± SD, seconds) and duration (264.1 ± 40.5 vs 296.3 ± 48.0, mean ± SD, min) of Horner's syndrome in the left and right SGB (P > 0.05). Compared with the control group (722 [708–726], median [IQR], bpm), the heart rate was significantly slowed down in the right SGB (475 [451.5–491], median [IQR], bpm) (P 0.05). The overall complication rate was 18.4%, with a brachial plexus block rate of 12.3%, a vascular injury rate of 4.6%, and a mortality rate of 1.5%, as well as no local anesthetic toxicity (includes bilateral implementation of SGB) or pneumothorax manifestations were found. Conclusions This method allows for the successful implementation of SGB in a mouse model.

Background: With the increasing prevalence of colorectal cancer (CRC), optimizing perioperative management is of paramount importance. This study investigates the potential of stellate ganglion block (SGB), known for its stress response-mediating effects, in improving postoperative recovery. We postulate that preoperative SGB may enhance the postoperative recovery of patients undergoing laparoscopic CRC surgery. Methods: We conducted a randomized controlled trial of 57 patients undergoing laparoscopic colorectal cancer surgery at a single center. Patients, aged 18–70 years, were randomly assigned to receive either preoperative SGB or standard care. SGB group patients received 10 mL of 0.2% ropivacaine under ultrasound guidance prior to surgery. Primary outcome was time to flatus, with secondary outcomes encompassing time to defecation, lying in bed time, visual analog scale (VAS) pain score, hospital stays, patient costs, intraoperative and postoperative complications, and 3-year mortality. A per-protocol analysis was used. Results: Twenty-nine patients in the SGB group and 28 patients in the control group were analyzed. The SGB group exhibited a significantly shorter time to flatus (mean [SD] hour, 20.52 [9.18] vs. 27.93 [11.69]; p = 0.012), accompanied by decreased plasma cortisol levels (mean [SD], postoperatively, 4.01 [3.42] vs 7.75 [3.13], p = 0.02). Notably, postoperative pain was effectively managed, evident by lower VAS scores at 6 h post-surgery in SGB-treated patients (mean [SD], 4.70 [0.91] vs 5.35 [1.32]; p = 0.040). Furthermore, patients in the SGB group experienced reduced hospital stay length (mean [SD], day, 6.61 [1.57] vs 8.72 [5.13], p = 0.042). Conclusions: Preoperative SGB emerges as a promising approach to enhance the postoperative recovery of patients undergoing laparoscopic CRC surgery. Clinical trial registration: ChiCTR1900028404, Principal investigator: Xia Feng, Date of registration: 12/20/2019. [ABSTRACT FROM AUTHOR]

Background: In patients with symptomatic cerebral vasospasm (CV) following aneurysmal subarachnoid hemorrhage who do not respond to medical therapy, urgent treatment escalation has been suggested to be beneficial for brain tissue at risk. In our routine clinical care setting, we implemented stellate ganglion block (SGB) as a rescue therapy with subsequent escalation to intraarterial spasmolysis (IAS) with milrinone for refractory CV. Methods: In this retrospective analysis from 2012 to 2021, patients with CV following aneurysmal subarachnoid hemorrhage who received an SGB or IAS were identified. Patients were assessed through neurological examination and transcranial Doppler. Rescue therapy was performed in patients with mean cerebral blood flow velocity (CBFV) ≥ 120 cm/s and persistent neurological deterioration/intubation under induced hypertension. Patients were reassessed after therapy and the following day. The Glasgow Outcome Scale was assessed at discharge and 6-month follow-up. Results: A total of 82 patients (mean age 50.16 years) with 184 areas treated with SGB and/or IAS met the inclusion criteria; 109 nonaffected areas were extracted as controls. The mean CBFV decrease in the middle cerebral artery on the following day was − 30.1 (± 45.2) cm/s with SGB and − 31.5 (± 45.2) cm/s with IAS. Mixed linear regression proved the significance of the treatment categories; other fixed effects (sex, age, aneurysm treatment modality [clipping or coiling], World Federation of Neurological Surgeons score, and Fisher score) were insignificant. In logistic regression, the presence of cerebral infarction on imaging before discharge from the intensive care unit (34/82) was significantly associated with unfavorable outcomes (Glasgow Outcome Scale ≤ 3) at follow-up. Conclusions: Stellate ganglion block and IAS decreased CBFV the following 24 h in patients with CV. We suggest SGB alone for patients with mild symptomatic CV (CBFV < 180 cm/s), while subsequent escalation to IAS proved to be beneficial in patients with refractory CV and severe CBFV elevation (CBFV ≥ 180 cm/s). [ABSTRACT FROM AUTHOR]

Ventricular arrhythmias are life-threatening cardiac events. Sympathetic nervous system blockade represents a crucial therapeutic method for refractory ventricular arrhythmias. Ultrasound (US) imaging for stellate ganglion block (SGB) suggests potential for its application to safer and more accurate methods. We had thirteen patients diagnosed with refractory ventricular arrhythmia and referred to the pain clinic for SGB. We visited the intensive care unit (ICU) and performed SGB with the lateral paracarotid approach technique in the ICU. Using a new approach, we easily performed SGB and felt the convenience of the procedure in the ICU. In eleven cases, we also confirmed that the effect of the block with the new technique was satisfactory. SGB, with the new technique, revealed efficiency in the recovery process of the patients. We recommended the lateral paracarotid approach technique for SGB when a patient in an ICU showed ventricular arrhythmias and should be treated with SGB. [ABSTRACT FROM AUTHOR]

Aims Percutaneous stellate ganglion block (PSGB) through single-bolus injection and thoracic epidural anaesthesia (TEA) have been proposed for the acute management of refractory ventricular arrhythmias (VAs). However, data on continuous PSGB (C-PSGB) are scant. The aim of this study is to report our dual-centre experience with C-PSGB and to perform a systematic review on C-PSGB and TEA. Methods and results Consecutive patients receiving C-PSGB at two centres were enrolled. The systematic literature review follows the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Our case series (26 patients, 88% male, 60 ± 16 years, all with advanced structural heart disease, left ventricular ejection fraction 23 ± 11%, 32 C-PSGBs performed, with a median duration of 3 days) shows that C-PSGB is feasible and safe and leads to complete VAs suppression in 59% and to overall clinical benefit in 94% of cases. Overall, 61 patients received 68 C-PSGBs and 22 TEA, with complete VA suppression in 63% of C-PSGBs (61% of patients). Most TEA procedures (55%) were performed on intubated patients, as opposed to 28% of C-PSGBs (P = 0.02); 63% of cases were on full anticoagulation at C-PSGB, none at TEA (P < 0.001). Ropivacaine and lidocaine were the most used drugs for C-PSGB, and the available data support a starting dose of 12 and 100 mg/h, respectively. No major complications occurred, yet TEA discontinuation rate due to side effects was higher than C-PSGB (18 vs. 1%, P = 0.01). Conclusion Continuous PSGB seems feasible, safe, and effective for the acute management of refractory VAs. The antiarrhythmic effect may be accomplished with less concerns for concomitant anticoagulation compared with TEA and with a lower side-effect related discontinuation rate. [ABSTRACT FROM AUTHOR]

Background Ventricular arrhythmias are a significant cause of morbidity and mortality in patients with ischaemic heart disease. When pharmacologic therapies, catheter ablation (CA), and implantable cardioverter defibrillator (ICD) are ineffective, stellate ganglion blockade (SGB), sympathectomy, and renal sympathetic denervation are considered. However, they are invasive for patients with high bleeding risk. We present a case of successfully recovering from haemodynamically unstable ventricular tachycardia (VT) storm with stellate ganglion phototherapy (SGP) in a non-invasive manner. Case summary A 73-year-old male presented to the emergency department with chief complaint of general malaise, resulting from VT storm associated with ischaemic cardiomyopathy. He had a history of CA and implantation of ICD. Despite multiple electrical cardioversions, pharmacologic therapies, and deep sedation with mechanical circulatory support (MCS), VT storm was not controlled. Thereafter, we irradiated the patient's neck with SGP to inhibit sympathetic neurological activity, which suppressed VT storm and dramatically improved his haemodynamic status. Discussion It has been reported that SGP is an alternative to SGB for refractory VT storm. Stellate ganglion phototherapy was easy and non-invasive to perform because we just irradiated the patient's neck with the near-infrared light for 5 min per day. If conventional therapies are ineffective in suppressing VT storm, SGP may be considered as a next step, especially for patients with high bleeding risk. However, since the effect of a single SGP lasts only 1–2 days, it should be performed as a bridge therapy to CA or sympathectomy. Stellate ganglion phototherapy may be effective in suppressing VT storm that requires MCS devices. [ABSTRACT FROM AUTHOR]

This article summarizes several studies related to cardiac health. The first study found that mineralocorticoid receptor antagonists (MRAs) are effective in reducing cardiovascular events in patients with and without heart failure, as well as preventing atrial fibrillation (AF) events. Another study suggests that clonal hematopoiesis of indeterminate potential (CHIP) may be a new risk factor for AF and other cardiac arrhythmias. The third study found that abnormal dynamic electrocardiogram (ECG) remodeling improved the prediction of sudden cardiac death (SCD). Additionally, percutaneous stellate ganglion block (PSGB) was effective in reducing arrhythmic events in patients with refractory electrical storms, and anticoagulation with edoxaban may be valuable for stroke prevention in patients with long atrial high-rate episodes (AHREs). [Extracted from the article]

Background and Aims An electrical storm (ES) is a clinical emergency with a paucity of established treatment options. Despite initial encouraging reports about the safety and effectiveness of percutaneous stellate ganglion block (PSGB), many questions remained unsettled and evidence from a prospective multicentre study was still lacking. For these purposes, the STAR study was designed. Methods This is a multicentre observational study enrolling patients suffering from an ES refractory to standard treatment from 1 July 2017 to 30 June 2023. The primary outcome was the reduction of treated arrhythmic events by at least 50% comparing the 12 h following PSGB with the 12 h before the procedure. STAR operators were specifically trained to both the anterior anatomical and the lateral ultrasound-guided approach. Results A total of 131 patients from 19 centres were enrolled and underwent 184 PSGBs. Patients were mainly male (83.2%) with a median age of 68 (63.8–69.2) years and a depressed left ventricular ejection fraction (25.0 ± 12.3%). The primary outcome was reached in 92% of patients, and the median reduction of arrhythmic episodes between 12 h before and after PSGB was 100% (interquartile range −100% to −92.3%). Arrhythmic episodes requiring treatment were significantly reduced comparing 12 h before the first PSGB with 12 h after the last procedure [six (3–15.8) vs. 0 (0–1), P <.0001] and comparing 1 h before with 1 h after each procedure [2 (0–6) vs. 0 (0–0), P <.001]. One major complication occurred (0.5%). Conclusions The findings of this large, prospective, multicentre study provide evidence in favour of the effectiveness and safety of PSGB for the treatment of refractory ES. [ABSTRACT FROM AUTHOR]

Post-stroke complex regional pain syndrome (CRPS) poses challenges in pain assessment for survivors. Stellate ganglion block (SGB) is a treatment, but evaluating its effectiveness is difficult for patients with communication limitations. Edema, a prominent symptom, can serve as an evaluation marker. Bioelectrical impedance analysis (BIA), assessing body composition and fluid status, is used independently of patient cooperation. This retrospective, observational pilot study aims to explore BIA's utility as an assessment tool post-SGB, revealing the effects and time courses of a single SGB on the bodily composition of post-stroke CRPS patients. Seven patients received ultrasound-guided SGB with a 5 mL solution containing 4 mL of 0.25% bupivacaine hydrochloride and 40 mg of triamcinolone into the prevertebral muscle space. BIA compared measures between affected and unaffected arms. The affected arm had higher segmental body water (SBW) and extracellular water ratios before SGB (p = 0.028 and p = 0.018, respectively). The SBW of the affected side, the SBW ratio, and the 1 and 5 kHz SFBIA ratios improved over time (p = 0.025, 0.008, 0.001, and 0.005, respectively). Rapid improvement occurred around 3 days post-injection, with maximum effects within approximately 1 week, persisting up to 3 weeks. SGB successfully reduced edema in post-stroke CRPS patients, with BIA serving as a useful tool for follow-up, facilitating the development of efficient treatment plans. [ABSTRACT FROM AUTHOR]

Patients with head and neck cancer (HNC) have ongoing pain but Stellate ganglion block which is a sympatholytic block may be a viable therapy for treating it. The data were retrospectively collected from five histopathologically confirmed HNC patients who had completed chemotherapy and radiation doses. Stellate ganglion block was given to these patients and was subsequently monitored for 3 months to assess pain alleviation and overall satisfaction. Over a 3-month period, there was a decrease in the pain levels with a better quality of life so the stellate ganglion block can be a promising modality for reducing the pain of HNC. [ABSTRACT FROM AUTHOR]

Background The use of percutaneous stellate ganglion block (SGB) in the management of drug-refractory electrical storm (ES) has been increasingly reported in the last years. Few data are available on the safety, duration, and dosage of local anaesthetic used. Case summary A 66-year-old male patient with a history of ischaemic cardiomyopathy and an implantable cardioverter–defibrillator (ICD) presented to the emergency room complaining several ventricular arrhythmias and ICD shocks received in the last 24 h. He was treated with many lines of anti-arrhythmic drugs but his condition deteriorated with cardiovascular instability and respiratory distress, so he was intubated. The ES still worsened (82 episodes of ventricular arrhythmias), so we performed an ultrasound-guided left SGB, using a modified technique, with success in suppressing the ventricular arrhythmias. The patient was then treated with electrophysiological study and catheter ablation. Discussion The ultrasound approach to SGB is feasible in emergency setting, and it is safe and effective also using a modified and easier technique in patient with difficult sonographic visualization of the neck structures. Moreover, it is possible and safe to use a combination of short-acting rapid-onset local anaesthetic with a long-lasting one with a good outcome. [ABSTRACT FROM AUTHOR]

Background: Stellate ganglion block (SGB) is effectively utilized in various sympathetically mediated pain conditions of head and neck, upper limb such as complex regional pain syndrome, postherpetic neuralgias, but there has been a paucity of evidence of SGB for the management of phantom limb pain (PLP). Methods: Ten upper extremity PLP patients underwent ultrasound-guided SGB block. Under real-time needle tip visualization and after ensuring negative aspiration, 5 mL of 1% lignocaine and 4 mg of dexamethasone were injected. Postprocedure pain score (numerical rating scale [NRS]) and patient satisfaction score (Likert scale) were noted, and patients were followed-up for the next 60 days. Results: The baseline NRS score (Mean [standard deviation]) of 7.8 (0.748) showed significant reduction (P < 0.001) to 2.8 (0.748) at immediate postinjection, to 2.6 (0.663) at day 7, at day 30 (2.9 [0.7]), and at day 60 (30.775). Most of the patients (80%–90%) were somewhat to very much satisfied with the treatment response (score 4–5 on Likert scale) at all the follow-up intervals. Only mild and transient adverse events were demonstrated in two patients who developed hoarseness of voice. Conclusion: Ultrasound-guided SGB effectively reduces pain and improves patient satisfaction in postamputee patients who developed PLP, over 2 months of the follow-up period. Further prospective randomized controlled trials over a larger duration with more sample size are needed to provide more concrete evidence.

Patients with head and neck cancer (HNC) have ongoing pain but Stellate ganglion block which is a sympatholytic block may be a viable therapy for treating it. The data were retrospectively collected from five histopathologically confirmed HNC patients who had completed chemotherapy and radiation doses. Stellate ganglion block was given to these patients and was subsequently monitored for 3 months to assess pain alleviation and overall satisfaction. Over a 3-month period, there was a decrease in the pain levels with a better quality of life so the stellate ganglion block can be a promising modality for reducing the pain of HNC.

This document provides a summary of various research articles related to the autonomic nervous system (ANS). The articles cover a range of topics including vagal nerve stimulation for stroke patients, ANS function in pregnancy, a new treatment for restless leg syndrome, the association between ANS and cognitive tasks, and the use of acupuncture for pain relief. Additionally, there is a study on brain connectivity in post-COVID patients. These studies offer valuable insights into the role of the ANS in different health conditions. [Extracted from the article]

The term "ventricular storm (VS)" is defined as the occurrence of two or more separate episodes of ventricular tachycardia or fibrillation (VT/VF) or three or more appropriate discharges of an implantable cardioverter defibrillator for VT/VF during a 24-h period. A patient in his early 40s was observed in the emergency department of our hospital and was admitted to the cardiac intensive care unit due to multiple episodes of VT. This led to the need for deep sedation with orotracheal intubation and mechanical ventilation. Intravenous lidocaine treatment was started; however, the patient had a recurrence of the episodes of VT. We decided to combine stellate ganglion block with epidural thoracic anesthesia. After the sympathetic block, there was no recurrence of the arrhythmic episodes. The patient was then transferred for ablation treatment. We demonstrated the efficacy of both techniques in managing a patient with multiple episodes of ventricular storm. [ABSTRACT FROM AUTHOR]

Stellate ganglion block (SGB) may have protective effects in patients at risk of vasospasm following subarachnoid hemorrhage (SAH) due to reduced sympathetic activity. However, the safety and clinical outcomes of SGB in this scenario are not definitively known. The objective was to evaluate the safety, clinical outcomes, and cerebral blood flow velocity in patients submitted to SGB or cervical sympathectomy with SAH. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review and meta-analysis of studies investigating SGB or cervical sympathectomy use in SAH were conducted. PubMed, Cochrane Library, and Embase were evaluated. Patients with mRS from 0 to 2, GOS from 4 to 5, or symptom resolution were considered favorable clinical outcomes. Related mortality was defined as death by vasospasm or delayed cerebral ischemia. The analysis included 8 studies comprising 182 patients. Only 2 studies employed SGB prophylactically. The results revealed favorable outcomes in 52% of patients (95% CI: 37%–65%). The overall incidence of complications was 2% (95% CI: 0% –26%). The mortality rate was 13% (95% CI: 7%–21%), with a vasospasm-related mortality rate of 11% (95% CI: 2%–20%). A decrease of cerebral blood flow velocity was reported in 4 studies. The notable reduction in cerebral blood flow velocity following SGB, alongside positive outcomes and a low occurrence of mortality and complications, highlights its significance as a therapeutic intervention for vasospasm following SAH. While the number of studies evaluating SGB as a preventive measure is limited, the promising results emphasize the importance of future research. [ABSTRACT FROM AUTHOR]

Restless legs syndrome is a movement disorder that seriously affects the quality of life of patients. It is characterized by marked discomfort mainly occurring in the deep tissues of the lower extremities, including deep muscle or bone chafing, as well as crawling sensations or pulling sensations. These sensations often cause patients to awaken after falling asleep and to feel the urge to walk around, which seriously affects their sleep quality. Patients with restless leg syndrome exhibit significantly enhanced sympathetic nerve activity and immune disorders, while stellate ganglion blockage can block sympathetic nerves and regulate immune cells and cytokines to maintain immune system homeostasis. We report three patients with restless legs syndrome complicated with severe nephrotic syndrome. After treatment with stellate ganglion block, the symptoms in the restless legs were relieved within 1 month, and the quality of sleep was significantly improved. Our findings suggest that stellate ganglion block has broad promise in the management of restless legs syndrome patients with severe comorbidities. [ABSTRACT FROM AUTHOR]

Background: Insomnia has become increasingly prevalent in modern society and is notoriously difficult to treat. Many patients exhibit a poor response to pharmacological interventions. Stellate ganglion block (SGB) has emerged as an effective method for managing insomnia; however, its efficacy may be compromised in some patients, primarily due to a variant vertebral artery anatomy. Case presentation: This case report describes a patient with severe insomnia accompanied by anxiety. Through cervical ultrasound scanning, we identified richly branched cervical arteries at the C6-C7 segment of the vertebral artery, along with anatomical variations, which could pose a heightened risk for the traditional SGB procedure. Therefore, after carefully adjusting the patient's positioning, we proceeded with ultrasound-guided SGB using a lateral paravein out-of-plane approach. Clinical signs of successful insomnia symptoms alleviation were consistently observed after each block utilizing this alternative technique multiple times in a single patient. Conclusion: Our report reveals a new lateral paravein out-of-plane approach for ultrasound-guided SGB to treat insomnia, which might be considered an alternative method. More studies should be carried out to confirm the efficacy of this new approach. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of ultrasound guided stellate ganglion block on digestive function and stress response in patients undergoing spinal surgery. Methods: Sixty patients with spinal surgery admitted to our hospital from January 2020 to January 2023 were selected as the research subjects. All patients were divided into an observation group and a control group using a random number table method, with 30 patients in each group. The patients in the control group were given intravenous general anesthesia, and the patients in the observation group were given ultrasound guided planetary ganglion block anesthesia after induction of intravenous general anesthesia. The changes of vital signs of the patients in the two groups at different times during the operation, and the changes of glutathione peroxidase (GSH px), superoxide dismutase (SOD), malondialdehyde (MDA) related stress factors before and after the operation were compared, and the patients in the two groups were compared 2 hours, 6 hours Compare the recovery time of digestive function and the 15 Recovery Quality Rating Scale (QoR-15) scores on the visual analogue scale (VAS) at 12 hours and 24 hours after surgery. Results: There was no difference in SPO2, HR, MAP, DBP, and SBP between the observation group at T1 to T4 (P>0.05), while there was a significant difference in SPO2, HR, MAP, DBP, and SBP between the control group at T1 to T4 (P<0.05). There was a significant difference in SPO2, HR, MAP, DBP, and SBP between the observation group and the control group at T2 and T3 (P<0.05); There was no difference in GSH-px, MDA, and SOD between the two groups of patients before surgery (P>0.05). At 2 hours after surgery, GSH-px, SOD, and MDA increased in both groups of patients, and the observation group was lower than the control group (P<0.05); The VAS scores of the observation group patients at 2 hours, 6 hours, and 12 hours after surgery were lower than those of the control group (P<0.05), and there was no significant difference in the VAS scores between the two groups at 24 hours after surgery (P>0.05); The QoR-15 score of patients at 24h, 48h and 72h after surgery was significantly lower than that of the control group (P<0.05), and the digestive recovery time of patients in the observation group was shorter than that of the control group (P<0.05). Conclusion: Ultrasound guided stellate ganglion block can stabilize patients' vital signs, reduce stress reactions, improve short-term postoperative pain, and promote digestive function recovery. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) is a chronic disorder resulting from exposure to traumatic events. In recent years, sympathetic nerve blocks have gained interest as an emerging treatment modality for PTSD. They have been shown to reduce autonomic dysfunction associated with PTSD symptoms, particularly in refractory and treatment-resistant patients. However, there is limited evidence regarding the technique's effectiveness in PTSD patients. Therefore, this scoping review was designed to update and summarize the current literature on this topic to inform the design of future clinical trials and studies. Our review of 22 studies (mostly case reports and series) included 1,293 PTSD patients who received sympathetic nerve blocks, primarily military service members and veterans, with a median age of 42.2 years. 0.5% Ropivacaine was the preferred anesthetic, and the right sided stellate ganglion block was the most commonly used technique. Relapse of symptoms was reported commonly, resulting in additional nerve block sessions. Most reported side effects were mild and transient. Despite the encouraging results, we remain cautious in interpreting the benefit of the technique due to the lack of sufficient standardized clinical trial data, heterogeneity in reported results, and the potential for bias in reporting. Future studies should focus on evaluating and addressing the technique's effectiveness, safety, tolerability, and indications. [ABSTRACT FROM AUTHOR]

Background: Stellate ganglion block (SGB) is effectively utilized in various sympathetically mediated pain conditions of head and neck, upper limb such as complex regional pain syndrome, postherpetic neuralgias, but there has been a paucity of evidence of SGB for the management of phantom limb pain (PLP). Methods: Ten upper extremity PLP patients underwent ultrasound‑guided SGB block. Under real‑time needle tip visualization and after ensuring negative aspiration, 5 mL of 1% lignocaine and 4 mg of dexamethasone were injected. Postprocedure pain score (numerical rating scale [NRS]) and patient satisfaction score (Likert scale) were noted, and patients were followed‑up for the next 60 days. Results: The baseline NRS score (Mean [standard deviation]) of 7.8 (0.748) showed significant reduction (P < 0.001) to 2.8 (0.748) at immediate postinjection, to 2.6 (0.663) at day 7, at day 30 (2.9 [0.7]), and at day 60 (30.775). Most of the patients (80%–90%) were somewhat to very much satisfied with the treatment response (score 4–5 on Likert scale) at all the follow‑up intervals. Only mild and transient adverse events were demonstrated in two patients who developed hoarseness of voice. Conclusion: Ultrasound‑guided SGB effectively reduces pain and improves patient satisfaction in postamputee patients who developed PLP, over 2 months of the follow‑up period. Further prospective randomized controlled trials over a larger duration with more sample size are needed to provide more concrete evidence. [ABSTRACT FROM AUTHOR]

Background: Hot flashes are common symptoms afflicting perimenopausal women. A stellate ganglion block (SGB) is believed to be an effective treatment for hot flashes; however, more evidence is needed to evaluate its safety and efficacy in relieving perimenopausal hot flashes. Objective: To investigate the efficacy and safety of SGB for the treatment of perimenopausal hot flashes. Methods: A randomized controlled trial was conducted at Shanxi Bethune Hospital. Forty perimenopausal women with hot flashes were recruited from April 2022 to November 2022 and randomly assigned to receive either 6 consecutive SGB treatments or 6 consecutive saline placebo treatments. The primary outcome was the change in hot flash symptom score from baseline to 12 weeks after treatment. The secondary outcomes were the change in hot flash symptom score from baseline to 12 weeks after treatment and the posttreatment Kupperman Index (KI) and Pittsburgh Sleep Quality Index (PSQI) scores. Results: Of the 40 randomized subjects, 35 completed the study. All the variables were significantly improved. During 12 weeks of follow-up, the hot flash scores, Kupperman Menopause Scale scores, and Pittsburgh Sleep Quality Scale scores decreased significantly. Two subjects in the SGB treatment group experienced transient hoarseness, and the incidence of related adverse events was 10%. No related adverse events occurred in the control group. Conclusion: Compared to the control treatment, SGB treatment was a safe and effective nonhormone replacement therapy that significantly relieved perimenopausal hot flashes and effectively improved sleep quality. Additional studies are needed to assess the long-term efficacy of this therapy. [ABSTRACT FROM AUTHOR]

Background: Stellate ganglion block (SGB) is a successful technique that can potentially maintain hemodynamics and terminate fatal arrhythmia. We aimed to study the efficacy of SGB on hemodynamic changes after on pump coronary artery bypass grafting (CABG) surgery. Methods: Forty patients who underwent CABG surgery at the Cardiac Surgical Academy Ain Shams University Hospital were randomly allocated to receive SGB or placebo between June 2020 and February 2021. After fulfilling the inclusion criteria, patients were classified as American Society of Anesthesiologists III and IV. Patients were randomly assigned to one of two groups utilizing a computer-generated block number in a sealed envelope. Group S (20 patients) received SGB, and Group C (20 patients) included matched controls who received a placebo solution in the SGB. Primary outcome was perioperative changes in heart rate and systolic and diastolic blood pressures. Secondary outcomes included the incidence of atrial and ventricular fibrillation, and myocardial ischemia in addition to the times from ICU admission to extubation, ICU stay, and hospital stay. Results: A statistically substantial increase in systolic and diastolic blood pressure as well as increased incidence of AF and VF was found in the control group compared to the SGB group with p values <0.001, <0.001, 0.037, and 0.028, respectively. Conclusion: SGB can reduce the hemodynamic responses to surgery and anesthesia, intraoperative tachyarrhythmias, and ICU and hospital stays. [ABSTRACT FROM AUTHOR]

Out of hospital cardiac arrest from shockable rhythms that is refractory to standard treatment is a unique challenge. Such patients can achieve neurological recovery even with long low-flow times if perfusion can somehow be restored to the heart and brain. Extracorporeal cardiopulmonary resuscitation is an effective treatment for refractory cardiac arrest if applied early and accurately, but often cannot be directly implemented by frontline providers and has strict inclusion/exclusion criteria. We present the case of a novel treatment strategy for out of hospital cardiac arrest due to refractory ventricular fibrillation utilizing Resuscitative Endovascular Balloon Occlusion of the Aorta-assisted cardiopulmonary resuscitation and intra-arrest left stellate ganglion blockade to achieve return of spontaneous circulation and eventual good neurological outcome after 101 minutes of downtime.