Sympathetic dystrophy may be the cause of pain in a significant number of cases. Neurolysis of Lumber sympathetic chain using alcohol/ phenol or RF ablation gives relief in Complex Regional Pain Syndrome/ causalgia/ Sympathetic dystrophy etc.
Stellate Ganglion Block
It has been utilized both as diagnostic as well as theurapeutic intervention.
It can be done by 3 approaches.:
1) Classical approach / C6 anterial approach.
Patient lye in supine position with a pillow under a shoulder and neck extended. The head kept in midline and mouth slightly open. C6 Tubercle or Chassaignacs tubercle can be palpated lateral to the cricoid cartilage at the medial order of the sternocledomastoid muscle. The syringe filled with medicine with 22/23-gauge needle should be introduced vertically over the tubercle. After aspiration the drug is injected at the site. Repeated aspiration should be done while injecting the drug.
2) C7 anterial approach.
As it is difficult to palpate C7 tubercle we should first palpate C6 tubercle and then should move one finger breath downwards to palpate C7 tubercle. The drug should be injected in the similar fashion. The advantage of C7 anterior approach is that lesser volume of drug is required and radio frequency ablation may be done by this approach.
3) Posterior approach.
Posterior approach is difficult to perform but it should be done in the following two conditions:
i) When by anterior approach there is no sign of upper extremity sympathetic block but there is evidence of Hornerï¿½s syndrome.
ii) In chemical sympathectomy of upper extremity is chosen.
Patient lye in prone position with a pillow under the chest then under C-arm lateral border of T2 T3 vertebral body is identified and 22gauge 9/12 cm. needle is introduced just lateral to the vertebral body with a final needle tip position at antero-lateral aspect of the vertical body. The final position is confirmed by spread of radio opaque dye. After confirming the final position approximately 5ml. of neurolytic agent is injected.
Evidence of Stellae Ganglion Block.
i) Miosis (Pinpoint pupil )
ii) Ptosis (Dropping of eye-lid )
iii) Enophthlanos (Sinking of eye ball )
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