Long-term benefits of stellate ganglion block in severe chronic refractoryangina

Angina pectoris that is refractory to optimal medication and revascularizat ion is becoming an increasingly common clinical problem. Recently the US Fo od and Drug Administration (FDA) approved transmyocardial laser revasculari zation (TMLR) for use in this group of patients and a large numbers of pati ents have already undergone this therapy. Unfortunately TMLR has is associa ted with an unacceptably high perioperative mortality (Cooley DA, Frazier O H, Kadipasaoglu KA, Lindenmeir MH, Pehlivanoglu S, KoIff JW, Wilansky S, Mo ore WH. Transmyocardiai laser revascularisation: clinical experience with t welve-month follow-up. J Thorac Cardiovasc Surg 1996;111:791-799; Horvath K A, Cohn LH, Cooley DA, Crew JR, Frazier GH, Griffith BP, Kadipasaoglu K, La nsing A, Mannting F, March R, Mirhoseini MR, Smith C. Transmyocardial laser revascularisation: results of a multi-centre transmyocardial laser revascu larisation used as sole therapy for end-stage coronary artery disease. J Th orac Cardiovasc Surg 1997;113:645-654; Schofield PM, Sharples LD, Caine N, Bums S, Tait S, Wistow T, Burton M, Wallwork J. Transmyocardial laser revas cularisation in patients with refractory angina: a randomised controlled tr ial. Lancet 1999;353:519-524), and recurrent refractory angina is common (A llen KB, Dowling RD, Fudge TL, Schoettle GP, Selinger SL, Gangahar OM, Ange ll WW, Petracek MR, Shaar CT, O'Neill WW. Comparison of transmyocardial rev ascularization with medical therapy in patients with refractory angina. N E ngl J Med 1999;341:1021-1028; Frazier OH, March RJ, Horvath KA, for the Tra nsmyocardial Carbon Dioxide Laser Revascularization Study Group. Transmyoca rdial revascularization with a carbon dioxide laser in patients with end-st age coronary artery disease. N Engl JMed 1999;341:1021-1028). Temporary sym pathectomy by stellate ganglion block (SGB) is in widespread use in a varie ty of chronic pain conditions and has long history of use in the management of angina (Moore DC. Stellate ganglion block. Springfield, IL: CC Thomas, 1954; Wiener L, Cox JW. Influence of stellate ganglion blockade on angina p ectoris and the post exercise electrocardiogram. Am J Med Sci 1966;252:289- 295). Here we describe a patient with end stage coronary artery disease and chronic refractory angina whose has been successfully treated with repeate d unilateral left SGBs following multiple bypass operations, angioplasty pr ocedures and laser therapy. This case report details his progress over a 34 month follow-up period. (C) 2000 International Association for the Study o f Pain. Published by Elsevier Science B.V. All rights reserved.