게시판
| 21KS-040 |
Comparative effectiveness of stellate ganglion block and epidural block in patients with cervical radicular pain
¹Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
2Department of Anesthesiology and Pain Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-Si, Republic of Korea
Background
Cervical epidural steroid injection (C-ESI) is often performed as a treatment for cervical radicular pain to reduce inflammatory reaction and improve blood flow. In addition, blockade of the sympathetic nerve system by a stellate ganglion block (SGB) can induce vasodilation and improvement of blood flow in head and neck. With these mechanisms, SGB may be effective in improving cervical radicular pain. The aim of this study was to evaluate and compare the effectiveness of C-ESI and SGB in patients with unilateral cervical radicular pain.
Methods
A total of 97 patients with unilateral cervical radicular pain were randomized to either the C-ESI group (n=49) or the SGB group (n=48). Parasagittal ipsilateral C-ESI was performed with 5 mL mixture of 1% lidocaine and 5 mg dexamethasone under fluoroscopic guidance. Ipsilateral SGB was performed with 6 mL of 1% lidocaine only under ultrasound-guidance. Patients were evaluated for pain intensity by numerical rating scale (NRS), physical function by neck disability index (NDI), and medication quanti, 3, and 6 months after the procedures. Global perceived effect of satisfaction (GPES) was used to assess patient satisfaction and improvement after the procedure. Infrared thermography was also performed before and 1month after the procedure.
Results
We observed the significant decrease of NRS for pain intensity, NDI for functional status, and MQS for medication requirement upto 6 months in C-ESI and SGB groups. However, there were no significant difference between two groups in NRS, NDI, MQS and GPES. Responders, defined robust combination of outcome measure, were 29/49 (59.2%) and 28/48 (58.3%) 6 months after C-ESI and SGB, respectively (p=0.937). Temperature of affected area measured by infrared thermography were increased in both C-ESI and SGB groups 1 months after the procedures without difference (p=0.787).
Conclusion
C-ESI and SGB may be similarly es with cervical radicular pain. In the treatment of cervical radicular pain, SGB may be effectively used while avoiding the risk of radiation and adverse effects of steroids when C-ESI is performed.
Reference
Fishman SM, Ballantyne JC, Rathmell JP. Bonica’s management of Pain. 4th ed. Lippincott Williams & Wilkins; 2010.
Narouze S. Ultrasound-guided stellate ganglion block: safty and efficacy. Curr Pain Headache Rep; 2014;18:424.
Cervical epidural steroid injection (C-ESI) is often performed as a treatment for cervical radicular pain to reduce inflammatory reaction and improve blood flow. In addition, blockade of the sympathetic nerve system by a stellate ganglion block (SGB) can induce vasodilation and improvement of blood flow in head and neck. With these mechanisms, SGB may be effective in improving cervical radicular pain. The aim of this study was to evaluate and compare the effectiveness of C-ESI and SGB in patients with unilateral cervical radicular pain.
Methods
A total of 97 patients with unilateral cervical radicular pain were randomized to either the C-ESI group (n=49) or the SGB group (n=48). Parasagittal ipsilateral C-ESI was performed with 5 mL mixture of 1% lidocaine and 5 mg dexamethasone under fluoroscopic guidance. Ipsilateral SGB was performed with 6 mL of 1% lidocaine only under ultrasound-guidance. Patients were evaluated for pain intensity by numerical rating scale (NRS), physical function by neck disability index (NDI), and medication quanti, 3, and 6 months after the procedures. Global perceived effect of satisfaction (GPES) was used to assess patient satisfaction and improvement after the procedure. Infrared thermography was also performed before and 1month after the procedure.
Results
We observed the significant decrease of NRS for pain intensity, NDI for functional status, and MQS for medication requirement upto 6 months in C-ESI and SGB groups. However, there were no significant difference between two groups in NRS, NDI, MQS and GPES. Responders, defined robust combination of outcome measure, were 29/49 (59.2%) and 28/48 (58.3%) 6 months after C-ESI and SGB, respectively (p=0.937). Temperature of affected area measured by infrared thermography were increased in both C-ESI and SGB groups 1 months after the procedures without difference (p=0.787).
Conclusion
C-ESI and SGB may be similarly es with cervical radicular pain. In the treatment of cervical radicular pain, SGB may be effectively used while avoiding the risk of radiation and adverse effects of steroids when C-ESI is performed.
Reference
Fishman SM, Ballantyne JC, Rathmell JP. Bonica’s management of Pain. 4th ed. Lippincott Williams & Wilkins; 2010.
Narouze S. Ultrasound-guided stellate ganglion block: safty and efficacy. Curr Pain Headache Rep; 2014;18:424.
