Daradia: The pain clinic feels your pain & sufferings. Located at Kolkata, India it has the facilities of diagnosis, treatment, research and training on pain management. Our patients suffer from headache, neck and back pain, knee pain, cancer pain etc. due to migraine, trigeminal neuralgia, arthritis, slipped disc, spondylosis, spondylitis, cancer etc. We use interventional pain management methods... radio-frequency procedures, spinal cord stimulation, Percutaneous Discectomy, vertebroplasty, Epiduroscopy, Ozone Nucleolysis etc.   More...

 

It is useful in the treatment of the following conditions :

1) Raymaud�s diseases .
2) Arterial embolism in arm .
3) Menier�s syndrome .
4) CRPS I , CRPS II .
It has been utilized both as diagnostic as well as theurapeutic intervention .

Contraindications:

1) Coagulation disorder.
2) Pneumothorax / Pneumonectomy on the opposite side.
3) Recent myocardial infarction.
4) Glaucoma.

Technique

It can be done by 3 approaches.

1) Classical approach / C6 anterial approach

Patient lye in supine position with a pillow under a shoulder and neck extended. The head kept in midline and mouth slightly open. C6 Tubercle or Chassaignac�s tubercle can be palpated lateral to the cricoid cartilage at the medial order of the sternocledomastoid muscle . The syringe filled with medicine with 22/23-gauge needle should be introduced vertically over the tubercle. After aspiration the drug is injected at the site. Repeated aspiration should be done while injecting the drug.

2) C7 anterial approach

As it is difficult to palpate C7 tubercle we should first palpate C6 tubercle and then should move one finger breath downwards to palpate C7 tubercle. The drug should be injected in the similar fashion. The advantage of C7 anterior approach is that lesser volume of drug is required and radio frequency ablation may be done by this approach.

3) Posterior approach

Posterior approach is difficult to perform but it should be done in the following two conditions:
i) When by anterior approach there is no sign of upper extremity sympathetic block but there is evidence of Horner�s syndrome .
ii) In chemical sympathectomy of upper extremity is chosen .

Patient lye in prone position with a pillow under the chest then under C-arm lateral border of T2 T3 vertebral body is identified and 22gauge 9/12 cm. needle is introduced just lateral to the vertebral body with a final needle tip position at antero-lateral aspect of the vertical body . The final position is confirmed by spread of radio opaque dye . After confirming the final position approximately 5ml. of neurolytic agent is injected .

Evidence of Stellae Ganglion Block

1) Evidence of Horner�s syndrome

i) Miosis (Pinpoint pupil )
ii) Ptosis (Dropping of eye-lid )
iii) Enophthlanos (Sinking of eye ball )

2) Conjunctival injection .
3) Nasal congestion.
4) Facial anhydrosis .
5) Engorgement of veins of arm .
6) Rise of skin temperature .


 
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