Editor-in-Chief: Kenneth D. Candido, MD

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  1. IPMReports2017;1;4;159-165 Safety and Comparative Efficacy of Ultrasound-Guided vs. Fluoroscopically-Guided Stellate Ganglion Block: A Retrospective Cohort Analysis and Focused Review of Literature
    Case Report/Literature Review
    Siddarth Thakur, MD, Billy K. Huh, MD, PhD, Lei Feng, MS, Yun Qing, PhD, and Christina Le-Short, MD.

BACKGROUND: Stellate ganglion blocks (SGBs) are a valuable diagnostic and therapeutic tool for sympathetically mediated pain syndromes. There are many different techniques used to achieve an effective blockade, but there is limited literature comparing the safety and efficacy of them.

OBJECTIVES: We aim to evaluate the incidence of complications and the change in numerical rating scale (NRS) pain scores of 4 groups using varied image-guided techniques: fluoroscopy, ultrasound, fluoroscopy and ultrasound, and no image guidance.

STUDY DESIGN: This is a retrospective cohort study and focused literature review.

SETTING: A university hospital outpatient pain clinic.

METHODS: A chart review of all SGBs performed at our institution from September 2010 to August 2014 was performed. Data were collected regarding the patients’ age, gender, indication for the procedure, NRS score at one to 3 months and 3 – 6 months, type of image guidance used, and occurrence of a procedure-related complication. A literature review was performed on PubMed in January 2017 using the following search terms: stellate ganglion block and ultrasound, fluoroscopy, safety, and efficacy; the search was made using the English language and human subject filters, yielding 92 results.

RESULTS: No complications occurred in the ultrasound group (n = 19), fluoroscopy and ultrasound group (n = 10), and no image guidance group (n = 2). Two complications occurred in the fluoroscopy group (n = 105; 1.9%). There were no statistically significant differences between the groups in terms of complications (P = 1), change in pain during the one to 3 month time-frame (P  = 0.157), or change in pain between the 3 – 6 month time-frame (P  = 0.484).

LIMITATIONS: The retrospective study design with a small sample size could prove to be a limitation.

CONCLUSIONS: No statistically significant difference was detectable between fluoroscopy, ultrasound, fluoroscopy and ultrasound, and no image guidance in terms of safety and efficacy. With this in mind, we cannot make any definitive recommendations about which technique should be used; rather, this decision should be based on clinician preference and clinical scenario.

IRB Approval: The research has been approved by the Institutional Review Board (PA14-0706).

Key words: Stellate ganglion block, techniques, fluoroscopy, ultrasound, sympathetically mediated pain, safety, complications, efficacy