Left Stellate Ganglion Block Has Only Small Effects on Left Ventricular Function in Awake Dogs Before and After Induction of Heart Failure

Background Left stellate ganglion block has been shown to increase heart rate and blood pressure, possible because of blockage of afferent vagal fibers from arterial baroreceptors in the aortic arch. Because efferent muscle sympathetic nerve activity (MSNA) is influenced by the arterial baroreflex, the hypothesis that left stellate ganglion block increases efferent MSNA recorded from the tibial nerve of humans was tested. Methods Twenty healthy male volunteers were sequentially assigned to one of three groups: stellate ganglion block (n = 10), in which 7 ml 1% mepivacaine was injected into the left stellate ganglion; placebo (n = 5), in which 7 ml of saline was injected into the left stellate ganglion; and intramuscular injection (n = 5), in which 7 ml mepivacaine was injected into the left deltoid muscle. Direct intraneural microneurographic recording with a tungsten microelectrode was used to record MSNA in the left tibial nerve. MSNA, heart rate, and blood pressure were recorded before and after injection in all groups. An additional five volunteers were studied with transthoracic echocardiography to examine the effect of stellate ganglion block on preload changes. Results Tibial nerve MSNA increased after mepivacaine injection to the left stellate ganglion but was unchanged after saline injection to the left stellate ganglion or mepivacaine injection into the deltoid muscle. Heart rate increased significantly after the left stellate ganglion block but did not change significantly after saline injection to the left stellate ganglion or after mepivacaine injection to the deltoid muscle. Systemic blood pressure did not change significantly in all groups. Left ventricular end-diastolic area and left ventricular end-diastolic circumference did not change after stellate ganglion block. Conclusions Tibial nerve MSNA increased during left stellate ganglion block with mepivacaine.

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Comparison of left internal mammary artery diameter before and after left stellate ganglion block

Annals of Cardiac Anaesthesia ◽

10.4103/0971-9784.119161 ◽

2013 ◽

Vol 16 (4) ◽

pp. 238 ◽

Cited By ~ 6

Author(s):

Divya Gopal ◽

NaveenG Singh ◽

AM Jagadeesh ◽

Ajay Ture ◽

Ashwini Thimmarayappa

Keyword(s):

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Stellate Ganglion ◽

Stellate Ganglion Block ◽

Ganglion Block ◽

Left Stellate Ganglion ◽

Before And After ◽

Internal Mammary

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Anatomical-based percutaneous left stellate ganglion block in patients with drug-refractory electrical storm and structural heart disease: a single-centre case series

EP Europace ◽

10.1093/europace/euaa319 ◽

2020 ◽

Author(s):

Simone Savastano ◽

Veronica Dusi ◽

Enrico Baldi ◽

Roberto Rordorf ◽

Antonio Sanzo ◽

...

Keyword(s):

Stellate Ganglion ◽

Case Series ◽

Stellate Ganglion Block ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Electrical Storm ◽

Ganglion Block ◽

Ventricular Ejection Fraction ◽

Left Stellate Ganglion ◽

Stellate Ganglion Blockade

Abstract Aims The adoption of percutaneous stellate ganglion blockade for the treatment of drug-refractory electrical storm (ES) has been increasingly reported; however, the time of onset of the anti-arrhythmic effects, the safety of a purely anatomical approach in conscious patients and the additional benefit of repeated procedures remain unclear. Methods and results This study included consecutive patients undergoing percutaneous left stellate ganglion blockade (PLSGB) in our centre for drug-refractory ES. Lidocaine, bupivacaine, or a combination of both were injected in the vicinity of the left stellate ganglion. Overall, 18 PLSGBs were performed in 11 patients (age 69 ± 13 years; 63.6% men, left ventricular ejection fraction 31.6 ± 16%). Seven patients received only one PLSGB; three underwent two procedures and one required three PLSGB and two continuous infusions to control ventricular arrhythmias (VAs). All PLSGBs were performed with an anatomical approach; lidocaine, alone, or in combination was used in 77.7% of the procedures. The median burden of VAs 1 h after each block was zero compared with five in the hour before (P < 0.001); 83% of the patients were free from VAs; the efficacy at 24 h increased with repeated blocks. The anti-arrhythmic efficacy of PLSGB was not related to anisocoria. No procedure-related complications were reported. Conclusion Anatomical-based PLSGB is a safe and rapidly effective treatment for refractory ES; repeated blocks provide additional benefits. Percutaneous left stellate ganglion blockade should be considered for stabilizing patients to allow further ES management.

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