Ultrasound Guided Sympathetic Blocks

Abstract

Ultrasound is a valuable tool for imaging critical soft tissue structures relevant to the sympathetic chain; guiding needle advancement, and confirming the spread of injectate in the proper fascial plane, without exposing healthcare providers and patients to the risks of radiation. There are only a few reports and observational studies that have demonstrated the advantages of ultrasound-guided stellate ganglion block over the traditional fluoroscopy-guided technique. However, despite a lack of scientific evidence in the past, pain practitioners followed a common-sense and sound-judgment approach when they transitioned from the blind approach to the now-routine fluoroscopic-guided approach for performing stellate ganglion block (SGB). And with the introduction of ultrasound guidance in pain management, many pain practitioners are following the same path. Ultrasound-guided stellate ganglion block, with direct visualization of the multiple vulnerable soft tissue structures compacted in a tight vascular space around the sympathetic chain, appears to be safer and more effective than traditional approaches. While future clinical studies will undoubtedly further establish ultrasound-guided SGB as the superior approach, the concept is already very appealing today, to the point that RCTs comparing ultrasound-guided SGB to the blind approach, or even to the fluoroscopy guided technique, may not be necessary in the future. That will be useful in treatment of pain syndromes as complex regional pain syndromes type I (reflex sympathetic dystrophy) and type II (causalgia), hyperhidrosis, refractory angina, phantom limb pain, herpes zoster, and pain of the head and neck. Also, it is of value in arterial vascular insufficiency which include Raynaud syndrome, scleroderma, obliterative vascular diseases, vasospasm, trauma, and emboli. No benefit is seen in patients with venous insufficiency.