Dong Yoon Park1, Seok Kang1, Hyo Jung Kang2, Jun Kyu Choi1, Jae Do Kim3, Joon Shik Yoon4. 1. Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, South Korea. 2. Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea. 3. Department of Physical Medicine and Rehabilitation, Korea University Graduate School, Seoul, South Korea. 4. Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, South Korea.
Abstract
BACKGROUND: The carotid artery must be avoided during stellate ganglion block. However, information on optimal neck position during the ultrasound-guided approach is limited. OBJECTIVE: To investigate the relation between the target area of the procedure and the carotid artery in different neck positions. DESIGN: Observational study. SETTING: Tertiary university. PARTICIPANTS: A total of 30 sides of the neck from 18 healthy participants were included. METHODS: An ultrasound transducer was placed at the level of the anterior tubercle of C6 with a short-axis view for measuring the distance from the tip of the C6 anterior tubercle to the margin of the carotid artery. The participants were first examined through ultrasonography in 3 different rotational neck positions (neutral, semicontralateral rotation, and full-contralateral rotation), in the supine position. After changing to the lateral decubitus position, the measurement was performed again in the same 3 neck positions. MAIN OUTCOME MEASURES: The C6 anterior tubercle to carotid distance was measured with ultrasound. RESULTS: The C6 anterior tubercle to carotid distance was the longest with full-contralateral neck rotation (P < .05). The distance was longer in the semicontralateral neck rotation compared with the neutral neck position (P < .05). Supine or decubitus positions did not affect the distance. CONCLUSIONS: We suggest that the full-contralateral neck rotation posture in either the supine or decubitus position is most beneficial for avoiding damage to the carotid artery during the ultrasound-guided stellate ganglion block. LEVEL OF EVIDENCE: Not applicable.
BACKGROUND: The carotid artery must be avoided during stellate ganglion block. However, information on optimal neck position during the ultrasound-guided approach is limited. OBJECTIVE: To investigate the relation between the target area of the procedure and the carotid artery in different neck positions. DESIGN: Observational study. SETTING: Tertiary university. PARTICIPANTS: A total of 30 sides of the neck from 18 healthy participants were included. METHODS: An ultrasound transducer was placed at the level of the anterior tubercle of C6 with a short-axis view for measuring the distance from the tip of the C6 anterior tubercle to the margin of the carotid artery. The participants were first examined through ultrasonography in 3 different rotational neck positions (neutral, semicontralateral rotation, and full-contralateral rotation), in the supine position. After changing to the lateral decubitus position, the measurement was performed again in the same 3 neck positions. MAIN OUTCOME MEASURES: The C6 anterior tubercle to carotid distance was measured with ultrasound. RESULTS: The C6 anterior tubercle to carotid distance was the longest with full-contralateral neck rotation (P < .05). The distance was longer in the semicontralateral neck rotation compared with the neutral neck position (P < .05). Supine or decubitus positions did not affect the distance. CONCLUSIONS: We suggest that the full-contralateral neck rotation posture in either the supine or decubitus position is most beneficial for avoiding damage to the carotid artery during the ultrasound-guided stellate ganglion block. LEVEL OF EVIDENCE: Not applicable.
Authors: Michael Farrell; Barbara I Karp; Panagiotis Kassavetis; William Berrigan; Simge Yonter; Debra Ehrlich; Katharine E Alter Journal: Toxins (Basel) Date: 2020-09-30 Impact factor: 4.546