The anatomical rationale for an upper limb sympathetic blockade: preliminary report

Area of Science:

• Anatomy
• Pain Management
• Surgical Techniques

Background:

• Stellate ganglion blockade (SGB) is crucial for diagnosing and managing chronic regional pain syndrome (CRPS).
• Existing SGB techniques vary, and inaccuracies can lead to misdiagnosis or missed treatment opportunities.
• A predictable and reproducible SGB is needed for effective upper limb sympathetic blockade.

Purpose of the Study:

• To evaluate a modified anterior technique for stellate ganglion blockade (SGB).
• To assess the spread and effectiveness of this modified SGB in cadavers for upper limb sympathetic blockade.

Main Methods:

• A modified anterior SGB technique was performed on 10 adult cadavers (19 sides).
• 10 ml of toluidine blue solution was injected, followed by median sternotomy to evaluate dye spread.
• A dual block (modified and standard techniques) was performed in one cadaver for comparison.

Main Results:

• The modified SGB consistently stained the lower cervical ganglia and proximal thoracic sympathetic trunk.
• Dye spread proximally to the seventh cervical vertebra and distally to the third, fourth, or seventh rib.
• Lateral spread blocked lower brachial plexus roots and extended beyond the nerve of Kuntz, while medial spread stained the vagus nerve.

Conclusions:

• The modified anterior SGB technique provides consistent blockade of the lower cervical ganglia and upper thoracic sympathetic trunk.
• This technique demonstrates potential for therapeutic use, especially in cases where sympathectomy is not an option.
• Further consideration of technique-specific pitfalls is warranted, but its utility for CRPS management is suggested.