Ultrasound-guided Stellate Ganglion Block for Upper Extremity Phantom Limb Pain - A Case Series

Abstract

Background: Stellate ganglion block (SGB) is effectively utilized in various sympathetically mediated pain conditions of head and neck, upper limb such as complex regional pain syndrome, postherpetic neuralgias, but there has been a paucity of evidence of SGB for the management of phantom limb pain (PLP). Methods: Ten upper extremity PLP patients underwent ultrasound-guided SGB block. Under real-time needle tip visualization and after ensuring negative aspiration, 5 mL of 1% lignocaine and 4 mg of dexamethasone were injected. Postprocedure pain score (numerical rating scale [NRS]) and patient satisfaction score (Likert scale) were noted, and patients were followed-up for the next 60 days. Results: The baseline NRS score (Mean [standard deviation]) of 7.8 (0.748) showed significant reduction (P < 0.001) to 2.8 (0.748) at immediate postinjection, to 2.6 (0.663) at day 7, at day 30 (2.9 [0.7]), and at day 60 (30.775). Most of the patients (80%–90%) were somewhat to very much satisfied with the treatment response (score 4–5 on Likert scale) at all the follow-up intervals. Only mild and transient adverse events were demonstrated in two patients who developed hoarseness of voice. Conclusion: Ultrasound-guided SGB effectively reduces pain and improves patient satisfaction in postamputee patients who developed PLP, over 2 months of the follow-up period. Further prospective randomized controlled trials over a larger duration with more sample size are needed to provide more concrete evidence.

Keywords

• stellate ganglion block
• phantom limb pain
• complex regional pain syndrome
• neuropathic pain
• postherpetic neuralgias