Article Figures & Data
Figures
- Figure 1
In stellate ganglion block, anesthetic is injected under ultrasonographic or fluoroscopic guidance into the stellate ganglion at the C6 or C7 vertebral level, targeting the sympathetic nerve chain that runs anterior to the transverse processes of the seventh cervical vertebra and the neck of the first rib.
Tables
- TABLE 1
Studies of stellate ganglion block for vasomotor symptoms in female breast cancer survivors
Study Treatment Outcome measures Results Rahimzadeh et al, 201835
RCT
N = 40SGB (10 mL 0.5% bupivacaine, laterality NR) vs paroxetine (7.5 mg) Baseline to 6 weeks
Hot flashes by Sloan scale
Seep disturbance measured via PSQIHot flash scores
SGB group: 42.35 to 10.50 (P < .001)
Paroxetine group: 36.85 to 10.94 (P < .001)
Sleep quality
Trend toward better sleep noted
No significant differences between SGB and paroxetine groups in hot flash and sleep quality improvement
Adverse events: None; 1 mild headacheOthman and Zaky, 201436
RCT
N = 40SGB (10 mL 0.5% bupivacaine, right lateral) vs pregabalin (75 mg twice daily) Baseline to 3 months
VMS frequency by self-reported daily hot fl ash diary and monthly questionnaire
Hot flashes using Sloan scaleVMS
Mild VMS: 28.0 to 10.0 (P = .005)
Moderate VMS: 83.2 to 8.0 (P = .005)
Very severe hot flashes: 51.2 to 0 (P = .005)
Hot flashes
Total score: 239.2 to 30.0 (P = .005)
No significant differences between SGB and pregabalin
Adverse events: NoneWalega et al, 201417
RCT
N = 40SGB (5 mL 0.5% bupivacaine, right lateral) vs sham injection Baseline to 4–6 months
Daily ambulatory sternal skin conductance monitoring and VMS diariesVMS
Reduced frequency in SGB group, event rate ratio: 0.71 (95% CI 0.64–0.99; P < .05)
Reduced frequency (moderate to very severe) in SGB group, event rate ratio: 0.50 (95% CI 0.35–0.71; P < .001)
Adverse events: Nonevan Gastel et al, 201332
Open-label, case-series
N = 20SGB (7 mL 0.5% bupivacaine, right lateral)
(1 excluded for lack of Horner syndrome after SGB)Baseline to 4 weeks
Hot flushes by self-reported diary and hygrometric hot flash recorder
Quality of life and sleep disturbance by HFRDIS, MENQOL, ESS, and PSQIHot flush score
Mean score decreased 34% (95% CI 18%–49%; P < .005)
Quality of life
Decrease in daily flush interference (HFRDIS)
Sleep disturbance
Decreased from 9.9 to 7.7 (P < .05) (PSQI)
Adverse events: redness of conjunctiva, minimal hoarseness in first hour after SGBHaest et al, 201231
Pilot and main study
N = 34SGB (10 mL 0.25% levobupivacaine up to 3 blocks, bilateral) Baseline to 1–24 weeks
Hot flashes by self-reported diary
Sleep quality assessed by self- reported diary and PSQIHot flash score
Reduced from baseline by 64% (95% CI 49%–74%)
Sleep quality
Improved from OR 3.4 (95% CI 1.6–7.2) at week 1 to 4.3 (95% CI 1.9–9.8) at week 24
Adverse events: NonePachman et al, 201133
Open-label, case series
N = 10 (8 evaluable)SGB (7 mL 0.5% bupivacaine, right lateral) Baseline to 6 weeks
Hot flashes by self-reported daily diary and weekly symptom questionnairesHot flashes
Frequency: 10.1 to 5.4
Score: 17.6 to 9.8
Adverse events: NoneLipov et al, 200834
Open-label, pilot study
N = 13SGB (7 mL 0.5% bupivacaine, up to 2 blocks, right lateral) Baseline to 12 weeks
Hot flashes by self-reported daily diary for Sloan hot flash score
Night awakenings by PSQISHot flash totals
At 2 weeks: from mean 79.4 (SD 37.4) per week to 49.9 (SD 39.9) (P < .0001)
At 12 weeks: very severe near zero (P < .0001)
Adverse events: NoneCI = confidence interval; ESS = Epworth Sleepiness Scale; HFRDIS = Hot Flash Related Daily Interference Scale; HT = hormone therapy; MENQOL = Menopause Specific Quality of Life; NR = not reported; OR = odds ratio; PSQI = Pittsburgh Sleep Quality Index; RCT = randomized clinical trial; SD = standard deviation; SGB = stellate ganglion block; VMS = vasomotor symptoms
