Differential effects of right versus left stellate ganglion block on left ventricular function in humans: An echocardiographic analysis

Study Objectives: To evaluate the effects of unilateral stellate ganglion b lockade an left ventricular function. Design: Prospective cohort of patients with chronic regional pain syndrome type I and II of the upper extremity requiring therapeutic stellate ganglio n blockade. Setting: University-affiliated hospital. Patients: Fifteen adult ASA physical status I and II patients with the diag nosis of chronic regional pain syndrome type I and II of the arm were studi ed. Right stellate ganglion block was performed in nine subjects and a left in six. Interventions: Stellate ganglion block was performed with 10 mL of 1% plain Xylocaine. Transthoracic echocardiograms were performed immediate ly prior and 30 min following the black. Measurements: Heart rate and blood pressure were monitored at regular inter vals. Global systolic function was determined by calculating ejection fract ion. Regional systolic motion was evaluated on the short axis and four-cham ber views using the American Society of Echocardiography criteria. Diastoli c function was assessed with pulsed-wave Doppler of the left ventricular ou tflow tract and the mitral valve. Data collected included isovolumic relaxa tion time and early and atrial velocity patterns. Main Results: A successful stellate ganglion block was achieved in all pati ents. Blood pressure and heart rate were not significantly different during data collection. Patients who underwent a right stellate ganglion block sh owed no significant differences in systolic or diastolic function. Followin g a left stellate ganglion block, global and regional systolic function rem ained unchanged. Isovolumic relaxation time was increased but did not reach statistical significance (80 +/- 13 ms to 88 +/- 9 ms; p = 0.09). Left ven tricular end-diastolic (LVEDV) and end-systolic volumes (LVESV) were signif icantly increased (LVEDV from 73 +/- 9 mL to 100 +/- 9 mL, p < 0.02; LVESV from 31 +/- 4 mL to 37 +/- 4 mL;, p < 0.03). Conclusions: In patients without cardiovascular disease, unilateral denerva tion of the left ventricle after stellate ganglion block produces no. clini cal deleterious effects on left ventricular function. (C) 2000 by Elsevier Science Inc.