Efficacy of stellate ganglion block with an adjuvant ketamine for peripheral vascular disease of the upper limbs
| Autor: | Ismile J Namazi, Anita I Kadam, Kalpana Rajendra Kulkarni |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Bupivacaine
medicine.medical_specialty business.industry Chronic pain medicine.disease stellate ganglion block Blockade Surgery Clonidine lcsh:RD78.3-87.3 Anesthesiology and Pain Medicine Opioid Sympatholytic lcsh:Anesthesiology peripheral vascular disease Anesthesia Neuropathic pain medicine Ketamine Clinical Investigation business medicine.drug |
| Zdroj: | Indian Journal of Anaesthesia Indian Journal of Anaesthesia, Vol 54, Iss 6, Pp 546-551 (2010) |
| ISSN: | 0976-2817 0019-5049 |
| Popis: | Stellate ganglion block (STGB) is commonly indicated in painful conditions like reflex sympathetic dystrophy, malignancies of head and neck, Reynaud's disease and vascular insufficiency of the upper limbs. The sympathetic blockade helps to relieve pain and ischaemia. Diagnostic STGB is usually performed with local anaesthetics followed by therapeutic blockade with steroids, neurolytic agents or radiofrequency ablation of ganglion. There is increasing popularity and evidence for the use of adjuvants like opioid, clonidine and N Methyl d Aspartate (NMDA) receptor antagonist - ketamine - for the regional and neuroaxial blocks. The action of ketamine with sympatholytic block is through blockade of peripherally located NMDA receptors that are the target in the management of neuropathic pain, with the added benefit of counteracting the "wind-up" phenomena of chronic pain. We studied ketamine as an adjuvant to the local anaesthetic for STGB in 20 cases of peripheral vascular disease of upper limbs during the last 5 years at our institution. STGB was given for 2 days with 2 ml of 2% lignocaine + 8 ml of 0.25% bupivacaine, followed by block with the addition of 0.5 mg/kg of ketamine for three consecutive days. There was significant pain relief of longer duration with significant rise in hand temperature. We also observed complete healing of the gangrenous fingers in 17/19 patients. |
| Databáze: | OpenAIRE |
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