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What is THE single most common complication of a stellate gangion block?
stellate ganglion complication
- Thread starter Jimmy LaRoux
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SGB complications depend on the perspective of the one asking the question. The Horner's syndrome is considered by some patients to be a complication since they cannot see out of the affected eye for several hours.
This block should always be performed under fluoroscopy with contrast due to the propensity for seizures (vascular uptake in this extremely vascular area). One of the largest surveys of SGB complications:
Anaesthesist. 1992 Mar;41(3):146-51.
[Complications and side effects of stellate ganglion blockade. Results of a
questionnaire survey]
[Article in German]
Wulf H, Maier C.
Klinik für Anästhesiologie und Operative Intensivmedizin im Klinikum
Christian-Albrechts-Universität zu Kiel.
Stellate ganglion blockade (SGB) is an established method in the therapy of
chronic pain syndromes. Complications are rare but can be life-threatening
(inadvertant subarachnoid or intra-arterial injection). Since no data are
currently available as to the incidence of complications, we sent questionnaires
to 76 departments of anaesthesiology in West Germany to evaluate this issue.
RESULTS. Thirty-nine questionnaires (51%) were returned, representing
approximately 45,000 SGBs; 82% of the departments prefer bupivacaine for SGB. The
incidence of severe complications was 1.7 in 1000 blockades. Most of these were
CNS complications (i.e., convulsions). A high subarachnoid block was reported in
6 cases, high epidural blockade in 3, pneumothorax in 9, and allergic reactions
in 2. All departments conduct aspiration tests before injection; 94% take
precautionary measures in case of respiratory failure (oxygen, ventilating
devices); 73% do not perform SGB without an assistant and an anticonvulsant drug
at hand; 72% place an intravenous line before SGB; 28% use ECG monitoring
routinely; and 53% administer a test dose of 0.5-2 ml local anaesthetic.
DISCUSSION. Severe complications following SGB are rare. Potentially
life-threatening complications usually arise from inadvertant subarachnoid or
intra-arterial injection. Aspiration tests and test doses obviously do not
guarantee proper administration. Placement of an intravenous line, ECG
monitoring, and the presence of an assistant are strongly recommended.
Anticonvulsant drugs as well as drugs and equipment for intubation and
resuscitation should be immediately available. The administration of very low
doses of opioids to the stellate ganglion has been shown to have similar
therapeutic results to local anaesthetic blocks, whereas the incidence of side
effects and complications is lower. Therefore, the administration of opioids to
sympathetic ganglia could provide an alternative therapeutic regimen for the
future.
This block should always be performed under fluoroscopy with contrast due to the propensity for seizures (vascular uptake in this extremely vascular area). One of the largest surveys of SGB complications:
Anaesthesist. 1992 Mar;41(3):146-51.
[Complications and side effects of stellate ganglion blockade. Results of a
questionnaire survey]
[Article in German]
Wulf H, Maier C.
Klinik für Anästhesiologie und Operative Intensivmedizin im Klinikum
Christian-Albrechts-Universität zu Kiel.
Stellate ganglion blockade (SGB) is an established method in the therapy of
chronic pain syndromes. Complications are rare but can be life-threatening
(inadvertant subarachnoid or intra-arterial injection). Since no data are
currently available as to the incidence of complications, we sent questionnaires
to 76 departments of anaesthesiology in West Germany to evaluate this issue.
RESULTS. Thirty-nine questionnaires (51%) were returned, representing
approximately 45,000 SGBs; 82% of the departments prefer bupivacaine for SGB. The
incidence of severe complications was 1.7 in 1000 blockades. Most of these were
CNS complications (i.e., convulsions). A high subarachnoid block was reported in
6 cases, high epidural blockade in 3, pneumothorax in 9, and allergic reactions
in 2. All departments conduct aspiration tests before injection; 94% take
precautionary measures in case of respiratory failure (oxygen, ventilating
devices); 73% do not perform SGB without an assistant and an anticonvulsant drug
at hand; 72% place an intravenous line before SGB; 28% use ECG monitoring
routinely; and 53% administer a test dose of 0.5-2 ml local anaesthetic.
DISCUSSION. Severe complications following SGB are rare. Potentially
life-threatening complications usually arise from inadvertant subarachnoid or
intra-arterial injection. Aspiration tests and test doses obviously do not
guarantee proper administration. Placement of an intravenous line, ECG
monitoring, and the presence of an assistant are strongly recommended.
Anticonvulsant drugs as well as drugs and equipment for intubation and
resuscitation should be immediately available. The administration of very low
doses of opioids to the stellate ganglion has been shown to have similar
therapeutic results to local anaesthetic blocks, whereas the incidence of side
effects and complications is lower. Therefore, the administration of opioids to
sympathetic ganglia could provide an alternative therapeutic regimen for the
future.
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Don't speak for the rest of us. 
