J Devulder1, M De Laat, G Rolly. 1. Department of Anesthesia Pain Clinic, University Hospital of Ghent, Belgium.
Abstract
BACKGROUND AND OBJECTIVES: The chronic intestinal pseudo-obstruction due to visceral myopathy is a disorder resembling bowel obstruction but without mechanical occlusion. Frequently, parenteral nutrition becomes the final palliative treatment. A patient affected with this syndrome for 16 years was suffering causalgic pain provoked by intraveneous perfusion. Stellate ganglion block was requested in the hope of maintaining the perfusion. METHODS: Stellate ganglion block not only stopped the pain but unexpectedly, it temporarily relieved the pseudo-obstruction symptoms. Two radiofrequency coagulations in the stellate ganglion prolonged the beneficial effects on gastrointestinal transit for more than 3 weeks, after which the symptoms returned. Multidisciplinary and multicenter advice was that further destructive treatments not be attempted. RESULTS: Repetitive stellate ganglion blocks with 2 mL of bupivacaine 0.75% restored gastrointestinal function for more than 3 weeks. However, after performance of radiofrequency coagulation, infiltration with bupivacaine was followed by hypermetropia on the right eye of 2 weeks duration. CONCLUSIONS: The relationship between stellate ganglion block and gastrointestinal function has not been described. This case report does not provide sufficient information to recommend this technique for pseudo-obstruction symptoms. Moreover, the result in this case is a fortuitous observation, lacking a clear scientific explanation. Further study may be warranted.
BACKGROUND AND OBJECTIVES: The chronic intestinal pseudo-obstruction due to visceral myopathy is a disorder resembling bowel obstruction but without mechanical occlusion. Frequently, parenteral nutrition becomes the final palliative treatment. A patient affected with this syndrome for 16 years was suffering causalgic pain provoked by intraveneous perfusion. Stellate ganglion block was requested in the hope of maintaining the perfusion. METHODS: Stellate ganglion block not only stopped the pain but unexpectedly, it temporarily relieved the pseudo-obstruction symptoms. Two radiofrequency coagulations in the stellate ganglion prolonged the beneficial effects on gastrointestinal transit for more than 3 weeks, after which the symptoms returned. Multidisciplinary and multicenter advice was that further destructive treatments not be attempted. RESULTS: Repetitive stellate ganglion blocks with 2 mL of bupivacaine 0.75% restored gastrointestinal function for more than 3 weeks. However, after performance of radiofrequency coagulation, infiltration with bupivacaine was followed by hypermetropia on the right eye of 2 weeks duration. CONCLUSIONS: The relationship between stellate ganglion block and gastrointestinal function has not been described. This case report does not provide sufficient information to recommend this technique for pseudo-obstruction symptoms. Moreover, the result in this case is a fortuitous observation, lacking a clear scientific explanation. Further study may be warranted.
Authors: Vasudha Goel; Amol M Patwardhan; Mohab Ibrahim; Carol L Howe; David M Schultz; Hariharan Shankar Journal: Reg Anesth Pain Med Date: 2019-04-16 Impact factor: 5.564