RSD Puzzle #123

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

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EPILEPSY, PAIN, MS

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RSD PUZZLE #123

Traumatic Stellate Ganglion Block

A Stellate Ganglion Block (SGB) is mainly a traumatic diagnostic procedure, it cannot be considered therapeutic because it doesn't last more than a few hours or days.

When performing an epidural block you do not stick the needle into the nerve cells (as is the case with SGB). When an epidural block is preformed with local anesthetic and an anti-inflammatory medication such as Depo - Medrol Ž in the back of the neck, it will last up to two to three months.

According to the late Dr. Bonica [1] (who was the best pain doctor in the world), the stellate ganglion block (SGB) has a 25% failure rate, because of the fact that the stellate ganglion is very variable in different individuals.

When the ganglion cannot be reached because of anatomical variations, then the repeated trauma during performing the block can cause damage to the nerve to the vocal cord causing difficulty with phonation (speaking). It also can cause rupture of blood vessels in the same area.

Incidentally the pain management doctors are very scared of giving epidural nerve blocks with anti-inflammatory medicine.

H. Hooshmand, M.D.

Reference:

1. Bonica JJ: Causalgia and other reflex sympathetic dystrophies. Post Grad Med 1973; 53:143-148

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