El bloqueo terapéutico de ganglio estrellado en el contexto actual

Omar Seguras Llanes

Texto completo:



Introducción: El bloqueo terapéutico de ganglio estrellado es un procedimiento para aliviar dolores crónicos de miembros superiores, cabeza y cuello. Actualmente se realiza con anestésicos locales más adyuvantes; pero en Cuba sólo se usan anestésicos locales para este bloqueo.

Objetivo: Cotejar información reciente sobre la pertinencia del uso de anestésicos locales con adyuvantes, para estimular la actualización de su práctica nacional acorde a las rutinas y los resultados de esta pericia en el contexto internacional.

Métodos: Se revisaron más de 150 informes científicos en línea, referentes a esta técnica a nivel mundial, respecto al uso de drogas y resultados terapéuticos, en bases de datos en inglés, español y portugués.

Desarrollo: El bloqueo anestésico precisa conocimientos de farmacología y habilidades prácticas para efectuarlo. La necesidad de anestésicos locales y adyuvantes varía, y depende del paciente y tipo de bloqueo. Para tratar el dolor crónico se usan también opioides, solos y con anestésicos locales. Se publican además beneficios razonables con el uso de ketamina y esteroides en combinación con anestésicos locales.

Conclusión: Los resultados terapéuticos más intensos y duraderos que se obtienen al aplicar anestésico local más adyuvante, sugieren actualizar estas prácticas a nivel nacional.

Palabras clave: bloqueo nervioso; ganglio estrellado; dolor crónico; distrofia simpática; síndrome de dolor regional complejo.

Palabras clave

bloqueo nervioso, ganglio estrellado, dolor crónico, distrofia simpática refleja, Síndrome de Dolor Regional Complejo


Moore KL, Dalley AF. Anatomía con orientación clínica. 4ª ed. Panamericana; 2005. p.1050.

Labat JJ, Riant T, Lassaux A, Rioult B, Rabischong B, Khalfallah M, Volteau C, Leroi AM, Ploteau S. Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: a randomised, double-blind, controlled trial. BJOG. 2017 Jan;124(2):251-260

Imani F, Hemati K, Rahimzadeh P, Kazemi MR, Hejazian K. Effectiveness of stellate ganglion block under fluoroscopy or ultrasound guidance in upper extremity CRPS. J Clin Diagn Res. 2016 Jan;10(1)

Xavier TV, de Oliveira TR, Mendes TC. Treatment of patients with painful blind eye using stellate ganglion block. Braz J Anesthesiol. 2016 Jan-Feb;66(1):75

Marples IL, Atkinson R. Stellate ganglion block. Pain Reviews 2001;8:3-11

Lipov E, Candido K. Efficacy and safety of stellate ganglion block in chronic ulcerative colitis. World J Gastroenterol. 2017 May 7;23(17):3193-3194

Kim H, Song SO, Jung G. A lateral paracarotid approach for ultrasound-guided stellate ganglion block with a linear probe. J Anesth. 2017 Jun;31(3):458-462

Kim WJ, Park HS, Yi MS, Koo GH, Shin HY. Evaluation of lung function and clinical features of the ultrasound-guided stellate ganglion block with 2 different

concentrations of a local anesthetic: a randomized controlled trial. Anesth Analg. 2017 Apr;124(4):1311-1316

Chen YQ, Xie YY, Wang B, Jin XJ. Effect of stellate ganglion block on hemodynamics and stress responses during CO2-pneumoperitoneum in elderly patients. J Clin Anesth. 2017 Feb;37:149-153

Summers MR, Nevin RL. Stellate ganglion block in the treatment of post-traumatic stress disorder: a review of historical and recent literature. Pain Pract. 2017 Apr;17(4):546-553

Díaz-Delgado R. Síndrome de dolor regional complejo. Protoc diagn ter pediatr. Servicio de Pediatría. Hospital Universitario Severo Ochoa. Leganés. Madrid 2014;1:189-95

Covarruvias A, Guevara Lopez U, Gutierrez C, Betancourt JA. Epidemiología del dolor crónico en Mexico. Rev Mex Anest. Mayo 2010;23(3)

Ghai A., Kaushik T., Wadhera R., Wadhera S. Stellate ganglion blockade-techniques and modalities. Acta Anaesth. Belg. 2016, 67, 1-5

Huang J, Ni Z, Finch P. Gasserian ganglion and retrobulbar nerve block in the treatment of ophthalmic postherpetic neuralgia: a case report. Pain Pract. 2016 Dec 20

Dilli E, Halker R, Vargas B, Hentz J, Radam T, Rogers R, Dodick D. Occipital nerve block for the short-term preventive treatment of migraine: A randomized, double-blinded, placebo-controlled study. Cephalalgia 2015 Oct;35(11):959-68

Rajesh MC, Deepa KV, Ramdas EK. Stellate ganglion block as rescue therapy in refractory ventricular tachycardia. Anesth Essays Res. 2017 Jan-Mar;11(1):266-267

Hayase J, Vampola S, Ahadian F, Narayan SM, Krummen DE. Comparative efficacy of stellate ganglion block with bupivacaine vs pulsed radiofrequency in a patient with refractory ventricular arrhythmias. J Clin Anesth. 2016 Jun;31:162-5

Alino J, Kosatka D, McLean B, Hirsch K. Efficacy of stellate ganglion block in the treatment of anxiety symptoms from combat-related post-traumatic stress disorder: a case series. Mil Med. 2013 Apr;178(4)

David L. Atlas of regional anesthesia. Filadelfia: WB Saunders; 1992. p.175-8

Omote K, Kawamata M, Namiki A. Adverse effects of stellate ganglion block on Raynaud’s phenomenon associated with progressive systemic sclerosis. Anesth Analg. 1993;77:1057-60

Lagade MRG, Poppers PJ. Stellate ganglion block: a therapeutic modality for arterial insufficiency of the arm in premature infants. Anesthesiology 1984;61:203-4

Winnie AP, Hartwell PW. Relationship between time of treatment of acute herpes zoster with sympathetic blockade and prevention of postherpetic neuralgia: clinical support for a new theory of the mechanism by which sympathetic blockade provides therapeutic benefit. Reg Anesth. 1993;18:277-82

Goodman LS, Gilmans A. Las bases farmacológicas de la terapéutica. 12da ed. México: McGraw Hill-Interamericana, 2011:841-842

Ouanounou A, Haas DA. Pharmacotherapy for the elderly dental patient. J Can Dent Assoc. 2015;80:f18

Mossetti V, Vicchio N, Ivani G. Local anesthetis and adjuvants in pediatric regional anesthesia. Curr Drug Targets. 2012 Jun;13(7):952-60

Acevedo RPE, Revilla PF, Cendón OMM. Influencia de lidocaína y clonidina sobre los requerimientos de sevoflurano, desflurano y fentanil durante anestesia general balanceada. Anales Medicos. Asociación Médica del Hospital ABC 2013; 48(1):38-41

Morgan G, Mikhail M. Anestesiología clínica. (5ta ed.). España: Editorial Manual Moderno. 2014

Andreas Goebel, Andrew Lawson, Steve Allen, Chris Glynn. Buprenorphine injection to the stellate ganglion in the treatment of upper body chronic pain syndromes. European Journal of Pain 2008;12(3):266-74

Makharita MY, Amr YM, El-Bayoumy Y. Effect of early stellate ganglion blockade for facial pain from acute herpes zoster and Incidence of postherpetic neuralgia. Pain Physician 2012;15;467-474

Khan MU, Ahmed I. Role of stellate ganglion block in post CABG sympathetically mediated chest pain. J Pak Med Assoc. 2007;57(9):470-2

Park JH, Min YS, Chun SM, Seo KS. Effects of stellate ganglion block on breast cancer-related lymphedema: comparison of various injectates. Pain Physician 2015;18(1):93-9

Harris CL, Hamid B, Rosenquist RW, Schultz-Stubner SH. Ganglionic local opioid application (GLOA) for treatment of chronic headache and facial pain. Reg Anesth Pain Med. 2006;31:460–2

Yong-Quan Chen, Xiao-Ju Jin, Zhao-Fang Liu, Mei-Fang Zhu, Effects of stellate ganglion block on cardiovascular reaction and heart rate variability in elderly patients during anesthesia induction and endotracheal intubation, Journal of Clinical Anesthesia 2015;27:140

Andrew McKeown, et al. Reporting of Sample Size Calculations in Analgesic Clinical Trials: ACTTION Systematic Review, The Journal of Pain 2015;16:199

Abdel OT, Saeid MM, Ismail OM, El Badrawy AM, Abdel NA: Ultrasound guided stellate ganglion block in postmastectomy pain syndrome: a comparison of ketamine versus morphine as adjuvant to bupivacaine. Journal of Anesthesiology 2014, Article ID 792569. Disponible en: http://dx.doi.org/10.1155/2014/792569

Sunder RA, Toshniwal G, DurejaGP: Ketamine as an adjuvant in sympathetic blocks for management of central sensitization following peripheral nerve injury. Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:22

Xie H, Wang X, Liu G, Wang G. Analgesic effects and pharmacokinetics of a low dose of ketamine preoperatively administered epidurally or intravenously. Clin J Pain 2003;19:317-22

Stotz M, Oehen HP, Gerber H. Histological findings after long-term infusion of intrathecal ketamine for chronic pain: a case report. J Pain Symptom Manage 1999;18:223-8

De Lima J, Beggs S, Howard R. Neural toxicity of ketamine and other NMDA antagonists. Pain 2000;88:311-2

Malinovsky JM, Lepage JY, Cozian A, Mussini JM, Pinaud M, Souron R. Is ketamine or its preservative responsible for neurotoxicity in the rabbit? Anesthesiology 1993;78:109-15

Moon HS, Chon JY, Lee SH, Ju YM, Sung CH: Long-term results of stellate ganglion block in patients with olfactory dysfunction. Korean Journal of Pain 2013;26(1):57–61

Cok OY, Deniz S, Eker HE, Oguzkurt L, Aribogan A. Management of isolated infraorbital neuralgia by ultrasound-guided infraorbital nerve block with combination of steroid and local anesthetic. J Clin Anesth. 2017 Feb;37:146-148

Huang J, Ni Z, Finch P. Gasserian ganglion and retrobulbar nerve block in the treatment of ophthalmic postherpetic neuralgia: a case report. Pain Pract. 2016 Dec 20

Uyar Türkyilmaz E(1), Camgöz Eryilmaz N(2), Aydin Güzey N(2), Moraloglu Ö. Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations. Braz J Anesthesiol. 2016 Sep-Oct;66(5):445-50

Brattwall M(1), Jildenstål P(2), Warrén Stomberg M(3), Jakobsson JG. Upper extremity nerve block: how can benefit, duration, and safety be improved? An update. F1000Res. 2016 May 18;5

Wisotzky EM(1), Saini V(2), Kao C. Ultrasound-guided intercostobrachial nerve block for intercostobrachial neuralgia in breast cancer patients: a case series. Physical Medicine and Rehabilitation 2016 Mar;8(3):273-7

YaDeau JT, Paroli L, Fields KG, Kahn RL, LaSala VR, Jules-Elysee KM, Kim DH, Haskins SC, Hedden J, Goon A, Roberts MM, Levine DS. Addition of dexamethasone and buprenorphine to bupivacaine sciatic nerve block: A Randomized Controlled Trial. Reg Anesth Pain Med. 2015 Jul-Aug;40(4):321-9

An K, Elkassabany NM, Liu J. Dexamethasone as adjuvant to bupivacaine prolongs the duration of thermal antinociception and prevents bupivacaine-induced rebound hyperalgesia via regional mechanism in a mouse sciatic nerve block model. PLoS One. 2015 Apr 9;10(4)

Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibers. Acta Anesthesiol Scand. 1990;34:335-338

Enlaces refback

  • No hay ningún enlace refback.

Copyright (c) 2020 Omar Seguras Llanes

Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.