TY - JOUR
T1 - Ultrasound Versus Fluoroscopy for Stellate Ganglion Block
T2 - A Cadaveric Study
AU - Hughey, Scott
AU - Schafer, Jeffrey
AU - Cole, Jacob
AU - Booth, Gregory
AU - Tuttle, Ralph
AU - Stedje-Larsen, Eric
N1 - Publisher Copyright:
© 2021 Published by Oxford University Press on behalf of the American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Objective: Post-Traumatic Stress Disorder (PTSD) is a common psychiatric disorder. Recent investigations have demonstrated effectiveness of Stellate Ganglion Blocks (SGB) for reducing symptoms associated with PTSD. Both fluoroscopic guided and ultrasound guided SGB have been described and are regularly used in clinical practice. This study sought to evaluate differences in block performance when comparing fluoroscopic versus ultrasound guided SGB. Design: Cadaveric Pilot Study. Setting: Academic Research Laboratory. Subjects: Ten Soft-Cured Human Cadavers. Methods: Ten soft-cured human cadavers were used after being at room temperature for 3 hours. Fluoroscopic and ultrasound guided injections were both performed on each cadaver, randomized to left or right sidedness. In total, 7 mL of omnipaque and methylene blue (5:1) was injected in each side. Injectate spread was assessed by measuring vertebral body spread under fluoroscopy. Successful staining of the sympathetic trunk was assessed under cadaveric dissection, with visualization of the sympathetic trunk stained with methylene blue. Results: Ultrasound guided injections resulted in successful staining in 9 of 10 injections, while 6 of 10 for fluoroscopic guidance (P =. 3034). The average spread in the ultrasound group was 4.0 compared with 5.2 for the fluoroscopic group (P =.088). In the four fluoroscopic guided injections which failed to stain, the injection occurred posterior to the prevertebral fascia. In the single ultrasound guided block that failed to stain, the injection was in the carotid sheath. Conclusions: While there appeared to be a trend favoring ultrasound guidance, no statistical significance was achieved. This was likely due to this being a limited pilot study. Numerous limitations exist in cadaveric studies, and future investigations should be completed to further study this comparison. That said, the use of the SGB may provide significant relief for patients suffering with PTSD.
AB - Objective: Post-Traumatic Stress Disorder (PTSD) is a common psychiatric disorder. Recent investigations have demonstrated effectiveness of Stellate Ganglion Blocks (SGB) for reducing symptoms associated with PTSD. Both fluoroscopic guided and ultrasound guided SGB have been described and are regularly used in clinical practice. This study sought to evaluate differences in block performance when comparing fluoroscopic versus ultrasound guided SGB. Design: Cadaveric Pilot Study. Setting: Academic Research Laboratory. Subjects: Ten Soft-Cured Human Cadavers. Methods: Ten soft-cured human cadavers were used after being at room temperature for 3 hours. Fluoroscopic and ultrasound guided injections were both performed on each cadaver, randomized to left or right sidedness. In total, 7 mL of omnipaque and methylene blue (5:1) was injected in each side. Injectate spread was assessed by measuring vertebral body spread under fluoroscopy. Successful staining of the sympathetic trunk was assessed under cadaveric dissection, with visualization of the sympathetic trunk stained with methylene blue. Results: Ultrasound guided injections resulted in successful staining in 9 of 10 injections, while 6 of 10 for fluoroscopic guidance (P =. 3034). The average spread in the ultrasound group was 4.0 compared with 5.2 for the fluoroscopic group (P =.088). In the four fluoroscopic guided injections which failed to stain, the injection occurred posterior to the prevertebral fascia. In the single ultrasound guided block that failed to stain, the injection was in the carotid sheath. Conclusions: While there appeared to be a trend favoring ultrasound guidance, no statistical significance was achieved. This was likely due to this being a limited pilot study. Numerous limitations exist in cadaveric studies, and future investigations should be completed to further study this comparison. That said, the use of the SGB may provide significant relief for patients suffering with PTSD.
UR - http://www.scopus.com/inward/record.url?scp=85118285986&partnerID=8YFLogxK
U2 - 10.1093/pm/pnab182
DO - 10.1093/pm/pnab182
M3 - Article
C2 - 34051103
AN - SCOPUS:85118285986
SN - 1526-2375
VL - 22
SP - 2307
EP - 2310
JO - Pain Medicine (United States)
JF - Pain Medicine (United States)
IS - 10
ER -