Cervical sympathetic block

Cervical sympathetic block, also known as stellate ganglion block, is designed to block the sympathetic nerves of the head, neck and upper limbs. More use of the front approach.

Curing disease:

Indication

Cervical sympathetic block is suitable for:

1. Unbearable pain in the limbs with sympathetic dysfunction of the upper extremities. It is often used for burning neuralgia. It can also be used for phantom limb pain, stump pain and Sudeck malnutrition after amputation.

2. Upper limb pain associated with circulatory dysfunction, such as Raynaud's disease, erythematous limb pain, and upper extremity vascular injury.

3. As a measure of preoperative predictive effect of sympathetic preganglionic fiber cutting in the upper thoracic segment.

Contraindications

1. Elderly patients with organic diseases such as liver, kidney or severe pulmonary dysfunction should be considered carefully.

2. Those who are allergic to injection drugs such as procaine.

Preoperative preparation

1. Tell the patient what it feels like during the blockade to make it work closely.

2. Inject local skin cleansing and disinfection.

Surgical procedure

Anesthesia and position

Local anesthesia is used at the needle insertion point. Excessive mental stress, intravenous injection of diazepam (diazepam) 5 ~ 10mg.

The front approach is in the supine position or in the sitting position, and the head is rotated 45° to the opposite side. After the approach, the patient was placed in the lateral position and the affected side was on the upper side.

Surgical procedure

1. The way ahead

(1) At the needle insertion point, at the intersection of the posterior edge of the sternocleidomastoid muscle and the clavicle 3 to 3.5 cm.

(2) When entering the needle, push the sternocleidomastoid and carotid artery forward with the left hand indicator, use 0.5% procaine as the ridge at the fingertip, and then use the 22cm 10cm long lumbar puncture needle. The ridge is pierced vertically and reaches the sixth cervical vertebrae. The needle is retracted a little and then inwardly and downwardly penetrated directly to the outside of the vertebral body. When no blood, air or cerebrospinal fluid is sucked back, the star ganglion is reached.

(3) 10 ml of 1% procaine was slowly injected in 1 min for 5-10 min. If Horner syndrome did not appear, the needle could be slightly moved and 5 to 10 ml of procaine was injected. In the presence of Horner syndrome, the astrocytic ganglion has been blocked. At this time, the patient may feel fever or pain relief in the affected limb, flushing of the affected limb, temperature rise, obvious turbulent pulsation of the radial artery, and strong dryness on the blocked side.

2. Rear approach

(1) The needle insertion point was 4 cm outside the seventh cervical spinous process, and 0.5% procaine was used as the ridge.

(2) The lumbar puncture needle of 20 or 22 is inserted from the ridge, and the direction of the needle is at an angle of 15° to the sagittal plane of the spine. When piercing about 4cm, you can touch the transverse process, withdraw the needle a little, and go up or down the transverse process, and continue to penetrate 2cm, you can reach the astrocytoma of the cervical vertebrae. After no blood, air or cerebrospinal fluid in the syringe, the patient can slowly inject 10% 15% of procaine into the presence of Horner syndrome and vasodilatation of the upper limb.

complication

Local infection: signs of infection, early treatment.