게시판
| 21KS-036 |
Ultrasound patient with Superior Vena Cava Syndrome : A case report
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
Introduction
Stellate Ganglion Block(SGB) is used for the treatment of several medical conditions including complex regional pain syndrome, post herpetic neuralgia and peripheral vascular disease. In recent studies, SGB is proven to be effective for reducing swelling in breast cancer related lymphedema. In this case, we report that ultrasound-guided SGB was effective for reducing pain in patient with Superior Vena Cava(SVC) syndrome.
Case Report
A 58-year-old female with uterine sarcoma and multiple metastasis was referred our pain clinic for severe pain on right shoulder and arm. She suffered from continuous dull pain with a numerical rating scale (NRS; 0=no pain, 10=worst pain imaginable) score 9. Physical examination revealed whole body edema especially right arm. Chest CT obtained previous day showed right pulmonary metastatic mass compressing right brachiocephalic vein(Fig.1).
Since patient was unable to lie down or lean backward on the bed due to dyspnea and possibility of desaturation, SGB was performed in sitting position with slight neck extension to the left side. EKG, HR, BP and pulse oximetry were monitored and oxygen supply continued throughout the procedure.
Ultrasound guided, C6 anterior tubercle and carotid artery was identified and needle was inserted with out-of-plane technique. After checking the blood vessel using color Doppler, 2% lidocaine 5mL was slowly injected at prevertebral fascia of longus colli muscle(Fig.2). Successful SGB was confirmed with the occurrence of Horner’s syndrome. After SGB, her pain slightly decreased, with an NRS ranging 3 to 5 out of 10.
A week later, she was referred to pain clinic again for relapsing pain in the riright upper limb. Ultrasound-guided SGB was performed in the same manner as last time and the patient felt much better than the day before.
10 day after last SGB, she was transferred to a hospice care facility, we could not follow up on her for long period of time.
Conclusion
Ultrasound-guided SGB can be helpful in patient with SVC syndrome for pain relief. If the patient is difficult to position, the physician should be very careful during the procedure.
1.Comparison Between the Effectiveness of Complex Decongestive Therapy and Stellate Ganglion Block in Patients with Breast Cancer-Related Lymphedema. Park MW, et al. Pain Physician. 2019
Stellate Ganglion Block(SGB) is used for the treatment of several medical conditions including complex regional pain syndrome, post herpetic neuralgia and peripheral vascular disease. In recent studies, SGB is proven to be effective for reducing swelling in breast cancer related lymphedema. In this case, we report that ultrasound-guided SGB was effective for reducing pain in patient with Superior Vena Cava(SVC) syndrome.
Case Report
A 58-year-old female with uterine sarcoma and multiple metastasis was referred our pain clinic for severe pain on right shoulder and arm. She suffered from continuous dull pain with a numerical rating scale (NRS; 0=no pain, 10=worst pain imaginable) score 9. Physical examination revealed whole body edema especially right arm. Chest CT obtained previous day showed right pulmonary metastatic mass compressing right brachiocephalic vein(Fig.1).
Since patient was unable to lie down or lean backward on the bed due to dyspnea and possibility of desaturation, SGB was performed in sitting position with slight neck extension to the left side. EKG, HR, BP and pulse oximetry were monitored and oxygen supply continued throughout the procedure.
Ultrasound guided, C6 anterior tubercle and carotid artery was identified and needle was inserted with out-of-plane technique. After checking the blood vessel using color Doppler, 2% lidocaine 5mL was slowly injected at prevertebral fascia of longus colli muscle(Fig.2). Successful SGB was confirmed with the occurrence of Horner’s syndrome. After SGB, her pain slightly decreased, with an NRS ranging 3 to 5 out of 10.
A week later, she was referred to pain clinic again for relapsing pain in the riright upper limb. Ultrasound-guided SGB was performed in the same manner as last time and the patient felt much better than the day before.
10 day after last SGB, she was transferred to a hospice care facility, we could not follow up on her for long period of time.
Conclusion
Ultrasound-guided SGB can be helpful in patient with SVC syndrome for pain relief. If the patient is difficult to position, the physician should be very careful during the procedure.
1.Comparison Between the Effectiveness of Complex Decongestive Therapy and Stellate Ganglion Block in Patients with Breast Cancer-Related Lymphedema. Park MW, et al. Pain Physician. 2019
