autonomic nerve block


Summary: Interruption of sympathetic pathways, by local injection of an anesthetic agent, at any of four levels: peripheral nerve block, sympathetic ganglion block, extradural block, and subarachnoid block.

Top Publications

  1. Loprinzi C, Barton D, Carns P. Stellate-ganglion block: a new treatment for hot flushes?. Lancet Oncol. 2008;9:506-7 pubmed publisher
  2. Wang Q, Wang X, Fu N, Liu J, Yao S. Stellate ganglion block inhibits formalin-induced nociceptive responses: mechanism of action. Eur J Anaesthesiol. 2005;22:913-8 pubmed
    ..The mechanism of its action may involve reduction of substance P in the spinal cord and plasma catecholamine release caused by noxious stimuli. ..
  3. Lee C, Chuang C, Liou J, Hsieh Y, Tsou M, Chen K. Successful management of contrast medium extravasation injury through stellate ganglion block and intra-arterial nitroglycerin. Acta Anaesthesiol Taiwan. 2011;49:116-8 pubmed publisher
    ..The clinical symptoms were improved after the above managements and the patient was discharged 7 days later without any sequela...
  4. Adachi M, Otsuki M, Akatsu M, Tase C. [The effects of heat stimulation and cold stress on the rats with cervical sympathectomy]. Masui. 2003;52:1293-9 pubmed
    ..Changes of beta-END by cold stress were similar in the S and Sx groups. These results suggest that SGB works systemically through hypothalamus endocrine system and affects stress hormone differently. ..
  5. Basinski A, Stefaniak T, Vingerhoets A, Makarewicz W, Kaska L, Stanek A, et al. Effect of NCPB and VSPL on pain and quality of life in chronic pancreatitis patients. World J Gastroenterol. 2005;11:5010-4 pubmed
    ..Both invasive pain treatment methods are effective in CP patients with chronic pain. ..
  6. Camilleri M, Toouli J, Herrera M, Kulseng B, Kow L, Pantoja J, et al. Intra-abdominal vagal blocking (VBLOC therapy): clinical results with a new implantable medical device. Surgery. 2008;143:723-31 pubmed publisher
    ..Intermittent, intra-abdominal vagal blocking is associated with significant EWL and a desirable safety profile. ..
  7. Sahai A, Lemelin V, Lam E, Paquin S. Central vs. bilateral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term effectiveness. Am J Gastroenterol. 2009;104:326-9 pubmed publisher
    ..i) Bilateral CPB/N is more effective than central CPB/N; (ii) bilateral CPB/N is safe, but on rare occasions can cause trauma to the left adrenal artery; it should therefore be avoided in patients with a bleeding diathesis. ..
  8. Noma N, Kamo H, Nakaya Y, Dezawa K, Young A, Khan J, et al. Stellate ganglion block as an early intervention in sympathetically maintained headache and orofacial pain caused by temporal arteritis. Pain Med. 2013;14:392-7 pubmed publisher
    ..This case demonstrates that SGB may relieve pain related to temporal arteritis and sympathetically maintained headache and orofacial pain by reducing noxious stimulation peripherally and decreasing central pain transmission centrally. ..
  9. Naja Z, Al Tannir M, Ziade F, Daher M. Management of cancer pain: different intervention techniques. J Med Liban. 2008;56:100-4 pubmed
    ..The intent of alternative therapies is to provide adequate and effective pain management in the oncology and palliative care arena with improvement in patient quality of life. ..

More Information


  1. O Toole T, Schmulewitz N. Complication rates of EUS-guided celiac plexus blockade and neurolysis: results of a large case series. Endoscopy. 2009;41:593-7 pubmed publisher
    ..EUS-guided CPB and CPN are reasonably safe procedures with tolerable side-effect profiles and low overall complication rates. ..
  2. Troeger H. [Prophylaxis of CRPS I and recurrent CRPS I]. Handchir Mikrochir Plast Chir. 2011;43:25-31 pubmed publisher
    ..Its consistent transposition cannot certainly prevent the CRPS in each case admittedly, the installment of the appearance or recurrence of a CRPS clearly lowers however. ..
  3. Guttuso T. Stellate ganglion block for treating hot flashes: a viable treatment option or sham procedure?. Maturitas. 2013;76:221-4 pubmed publisher
  4. Joffe A, Wood K, Coursin D. Sympathetic blockade for pulmonary embolus: novel therapy or novelty?. Crit Care Med. 2007;35:2653-4 pubmed
  5. Carroll I. Celiac plexus block for visceral pain. Curr Pain Headache Rep. 2006;10:20-5 pubmed
    ..In addition, neurolytic celiac plexus block may prolong survival, but the data supporting this remain controversial. The optimal technique for accomplishing neurolytic celiac plexus block remains undetermined. ..
  6. Yilmazlar A, Bilgel H, Donmez C, Guney A, Yilmazlar T, Tokat O. Comparison of ilioinguinal-iliohypogastric nerve block versus spinal anesthesia for inguinal herniorrhaphy. South Med J. 2006;99:48-51 pubmed
    ..05). The use of IHNB for patients undergoing herniorrhaphy resulted in a shorter time-to-home readiness, quicker oral intake post surgery, and no need for recovery room care, when compared with the use of SA. ..
  7. Tomita R, Tanjoh K, Fzuisaki S, Ikeda T, Koshinaga T. The role of interleukin-1 beta (IL-1beta) in the normal human colon in vitro. Hepatogastroenterology. 2005;52:464-8 pubmed
    ..These findings suggest that IL-1beta plays an important role in regulating relaxation of the normal human colon via nitregic nerves, and that NO plays a role as a neurotransmitter in the NANC inhibitory nerves. ..
  8. Pachman D, Barton D, Carns P, Novotny P, Wolf S, Linquist B, et al. Pilot evaluation of a stellate ganglion block for the treatment of hot flashes. Support Care Cancer. 2011;19:941-7 pubmed publisher
    ..The results of this pilot trial support that stellate ganglion blocks may be a helpful therapy for hot flashes. A prospective placebo-controlled clinical trial should be done to more definitively determine this contention. ..
  9. Adler D, Jacobson B, Davila R, Hirota W, Leighton J, Qureshi W, et al. ASGE guideline: complications of EUS. Gastrointest Endosc. 2005;61:8-12 pubmed
    ..Clinical consideration may justify a course of action at variance to the recommendations. ..
  10. Pather N, Singh B, Partab P, Ramsaroop L, Satyapal K. The anatomical rationale for an upper limb sympathetic blockade: preliminary report. Surg Radiol Anat. 2004;26:178-81 pubmed
    ..The pitfalls of this technique aside, we suggest that this technique be reserved for therapeutic purposes, particularly when sympathectomy is not possible. ..
  11. Sahin L, Gul R, Mizrak A, Deniz H, Sahin M, Koruk S, et al. Ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas. J Vasc Surg. 2011;54:749-53 pubmed publisher
    ..001), and 680.6 ± 96.7 vs 405.3 ± 76.2 (P < 0.001). When used for AVF access surgery, infraclavicular brachial plexus block provides higher blood flow in the radial artery and AVF than is achieved with infiltration anesthesia. ..
  12. Matsuura M, Matsuura M, Ando F, Sahashi K, Torii Y, Hirose H. [The effect of stellate ganglion block on prolonged post-operative ocular pain]. Nippon Ganka Gakkai Zasshi. 2003;107:607-12 pubmed
    ..6 times it was only 66.7% effective. SGB may be useful for the treatment of prolonged post-operative ocular pain, but the elimination of neuropathic pain is more difficult than the elimination of nociceptive pain. ..
  13. Takahashi M, Yoshida A, Ohara T, Yamanaka H, Yamamoto Y, Toraiwa S, et al. Silent gastric perforation in a pancreatic cancer patient treated with neurolytic celiac plexus block. J Anesth. 2003;17:196-8 pubmed
  14. Ilfeld B. Paraverbal approach to the brachial plexus. Reg Anesth Pain Med. 2003;28:581-2; author reply 583-5 pubmed
  15. Freise H, Fischer L. Intestinal effects of thoracic epidural anesthesia. Curr Opin Anaesthesiol. 2009;22:644-8 pubmed publisher
    ..Further research concerning the use of TEA in major laparoscopic procedures and its potential to improve or endanger anastomotic healing is warranted. The experimental studies of TEA in critical illness should be expanded. ..
  16. Camilleri M, Toouli J, Herrera M, Kow L, Pantoja J, Billington C, et al. Selection of electrical algorithms to treat obesity with intermittent vagal block using an implantable medical device. Surg Obes Relat Dis. 2009;5:224-9; discussion 229-30 pubmed publisher
  17. Mankowski J, Kingston J, Moran T, Nager C, Lukacz E. Paracervical compared with intracervical lidocaine for suction curettage: a randomized controlled trial. Obstet Gynecol. 2009;113:1052-7 pubmed publisher
    ..Providers should feel confident that both techniques provide equally effective and acceptable analgesia. ..
  18. Berti P, Materazzi G, Bogazzi F, Ambrosini C, Martino E, Miccoli P. Combination of minimally invasive thyroid surgery and local anesthesia associated to iopanoic acid for patients with amiodarone-induced thyrotoxicosis and severe cardiac disorders: a pilot study. Langenbecks Arch Surg. 2007;392:709-13 pubmed
    ..Minimally invasive video-assisted thyroidectomy under regional anesthesia can be proposed as resolution of amiodarone-induced thyrotoxicosis in high risk patients with severe cardiac disorders, after preparation with iopanoic acid. ..
  19. Manchikanti L, Manchikanti K, Pampati V, Brandon D, Giordano J. The prevalence of facet-joint-related chronic neck pain in postsurgical and nonpostsurgical patients: a comparative evaluation. Pain Pract. 2008;8:5-10 pubmed publisher
    ..The prevalence of cervical facet joint pain was similar in both postsurgical and nonsurgical patients. ..
  20. Cordoví de Armas L, Espinaco Valdés J, Jiménez Paneque R, Costa Hidalgo T, Vallongo Menéndez M. [Improved detection of the pulse oximeter signal with a digital nerve block in patients in poor health status]. Rev Esp Anestesiol Reanim. 2008;55:481-6 pubmed
    ..1% vs 4.4% and 35.9% vs 15.7%, respectively; P<.001). A digital nerve block can be used to prevent pulse oximetry failures in conditions of low peripheral perfusion. ..
  21. Hadzic A, Sala Blanch X, Xu D. Ultrasound guidance may reduce but not eliminate complications of peripheral nerve blocks. Anesthesiology. 2008;108:557-8 pubmed publisher
  22. Goadsby P. Neuromodulatory approaches to the treatment of trigeminal autonomic cephalalgias. Acta Neurochir Suppl. 2007;97:99-110 pubmed
    ..Neuromodulatory procedures are a promising avenue for these highly disabled patients with treatment refractory TACs. ..
  23. Vicent O, Hubler M, Kirschner S, Koch T. [The value of regional and general anaesthesia in orthopaedic surgery]. Orthopade. 2007;36:529-36 pubmed
    ..This article summarises the value of special anaesthetic techniques, especially regional anaesthesia, in orthopaedic surgery and discusses their impact on several postoperative outcome goals. ..
  24. Andresen R, Radmer S, Nickel J, Fischer G, Brinckmann W. [Ambulatory CT-assisted thoracic sympathetic block as an additional approach to treatment of complex regional pain syndromes after sport injuries]. Sportverletz Sportschaden. 2009;23:35-40 pubmed publisher
    ..Outpatient CT-assisted temporary sympathetic nerve blockade is an effective and low-complication therapeutic option for the supportive treatment of patients with CRPS. ..
  25. Arslan M, Yazici G, Dilek U. Pudendal nerve block for pain relief in episiotomy repair. Int J Gynaecol Obstet. 2004;87:151-2 pubmed
  26. Lipov E, Navaie M, Brown P, Hickey A, Stedje Larsen E, McLay R. Stellate ganglion block improves refractory post-traumatic stress disorder and associated memory dysfunction: a case report and systematic literature review. Mil Med. 2013;178:e260-4 pubmed publisher
    ..Future studies that employ robust epidemiologic methodologies are needed to generate confirmatory evidence that would substantiate SGB's clinical utility as an adjunctive treatment option for PTSD. ..
  27. Vielvoye Kerkmeer A. Re: CT-guided neurolytic splanchnic nerve block. J Pain Symptom Manage. 2002;24:455 pubmed
  28. Horstman D, Riley E, Carvalho B. A randomized trial of maximum cephalad sensory blockade with single-shot spinal compared with combined spinal-epidural techniques for cesarean delivery. Anesth Analg. 2009;108:240-5 pubmed publisher
  29. Lipov E, Kelzenberg B. Sympathetic system modulation to treat post-traumatic stress disorder (PTSD): a review of clinical evidence and neurobiology. J Affect Disord. 2012;142:1-5 pubmed publisher
    ..The main focus of the review is the application of stellate ganglion blocks (SGBs) or a local anesthetic blockade of the sympathetic ganglion in the neck. ..
  30. Contreras Dominguez V, Carbonell Bellolio P, Sanzana E, Ojeda Greciet A, Orrego Santos R. [Efficacy of a continuous interscalene block vs intra-articular analgesia for postoperative pain in arthroscopic acromioplasty]. Rev Esp Anestesiol Reanim. 2008;55:475-80 pubmed
    ..Postoperative pain in the first 12 hours after shoulder surgery can be adequately managed with either IA or CIB. CIB is more effective than IA between 12 and 48 hours after surgery. ..
  31. Désiré L, Veissier I, Després G, Delval E, Toporenko G, Boissy A. Appraisal process in sheep (Ovis aries): interactive effect of suddenness and unfamiliarity on cardiac and behavioral responses. J Comp Psychol. 2006;120:280-7 pubmed
    ..The combination of suddenness and unfamiliarity enhanced both the heart rate increase and the behavioral orientation response. These results support the hypotheses of specificity and modulation of emotional expressions. ..
  32. Yamaguchi K, Kobayashi K, Ogura Y, Nakamura K, Nakano K, Mizumoto K, et al. Radiation therapy, bypass operation and celiac plexus block in patients with unresectable locally advanced pancreatic cancer. Hepatogastroenterology. 2005;52:1605-12 pubmed
  33. Blumenthal S, Ekatodramis G, Nadig M, Borgeat A. Paravertebral approach to the brachial plexus: an anatomic improvement in technique--is it really advantageous to come from behind?. Reg Anesth Pain Med. 2003;28:582-3; author reply 583-5 pubmed
  34. Firat Y, Kizilay A, Ozturan O, Ekici N. Experimental otoacoustic emission and auditory brainstem response changes by stellate ganglion blockage in rat. Am J Otolaryngol. 2008;29:339-45 pubmed publisher
    ..To recommend SG blockage as a treatment option in the vascular pathologies of cochlea, further investigation should assess the efficiency of ganglion blockage in hearing parameters of rats with impaired cochlear blood flow. ..
  35. Seamans D, Wong G, Wilson J. Interventional pain therapy for intractable abdominal cancer pain. J Clin Oncol. 2003;21:92s-94s pubmed
  36. Levy M, Wiersema M. EUS-guided celiac plexus neurolysis and celiac plexus block. Gastrointest Endosc. 2003;57:923-30 pubmed
  37. Celiktas M, Birbicer H, Aikimbaev K, Ozbek H, Akgul E, Binokay F. Utility of color duplex sonography in the assessment of efficacy of the stellate ganglion blockade. Acta Radiol. 2003;44:494-7 pubmed
    ..Hemodynamic changes assessed by spectral Doppler parameters could be used as sensitive and objective measurements of peripheral sympathetic nervous activity and vascular tonus, and may confirm a successfully performed SGB. ..
  38. Sakamoto H, Kitano M, Komaki T, Imai H, Kamata K, Kudo M. Endoscopic ultrasound-guided neurolysis in pancreatic cancer. Pancreatology. 2011;11 Suppl 2:52-8 pubmed publisher
    ..This review provides evidence for the efficacy of EUS-CPN. Particular attention is paid to the two new techniques of EUS-guided neurolysis, EUS-CGN and EUS-BPN. ..
  39. Akhan O, Ozmen M, Basgun N, Akinci D, Oguz O, Koroglu M, et al. Long-term results of celiac Ganglia block: correlation of grade of tumoral invasion and pain relief. AJR Am J Roentgenol. 2004;182:891-6 pubmed
    ..Percutaneous celiac ganglia block, particularly when performed in earlier stages of ganglia invasion, is an effective, easy, and safe procedure with successful long-term results. ..
  40. Yi X, Aubuchon J, Zeltwanger S, Kirby J. Necrotic arachnidism and intractable pain from recluse spider bites treated with lumbar sympathetic block: a case report and review of literature. Clin J Pain. 2011;27:457-60 pubmed publisher
    ..We discuss the benefit of sympathetic blockade not only for neuropathic pain but also possibly as a treatment for necrotic arachnidism from a brown recluse spider bite. ..
  41. Saberski L, Ahmad M, Wiske P. Sphenopalatine ganglion block for treatment of sinus arrest in postherpetic neuralgia. Headache. 1999;39:42-4 pubmed
    ..This report emphasizes that a sphenopalatine ganglion blockade can be employed in the treatment and prevention of sinus arrest associated with postherpetic trigeminal distribution neuralgia. ..
  42. Huntoon M. The vertebral artery is unlikely to be the sole source of vascular complications occurring during stellate ganglion block. Pain Pract. 2010;10:25-30 pubmed publisher
    ..It is anatomically possible, therefore, that accidental injection or induced spasm of these vessels and not the vertebral arteries is responsible for some cases of seizure, hematoma, or other vascular complications during SGB. ..
  43. White P. Choice of peripheral nerve block for inguinal herniorrhaphy: is better the enemy of good?. Anesth Analg. 2006;102:1073-5 pubmed
  44. Stout C, Maron B, VanderBrink B, Estes N, Link M. Importance of the autonomic nervous system in an experimental model of commotio cordis. Med Sci Monit. 2007;13:BR11-5 pubmed
    ..Thus, vagotonic and sympathetic surges likely do not contribute to the syndrome of sudden death due to chest blows in young people and athletes. ..
  45. Mitsis G, Zhang R, Levine B, Tzanalaridou E, Katritsis D, Marmarelis V. Autonomic neural control of cerebral hemodynamics. IEEE Eng Med Biol Mag. 2009;28:54-62 pubmed publisher
    ..These observations were based on assessing static measures of cerebral circulation, i.e., mean values of artevial blood pressure (ABP) and CBF with a low time resolution. ..
  46. Jack N, Slappendel R, Gielen M. Don't make an easy block more difficult!. Reg Anesth Pain Med. 2003;28:580-1; author reply 583-5 pubmed
  47. Toshniwal G, Sunder R, Thomas R, Dureja G. Management of complex regional pain syndrome type I in upper extremity-evaluation of continuous stellate ganglion block and continuous infraclavicular brachial plexus block: a pilot study. Pain Med. 2012;13:96-106 pubmed publisher
    ..Hence, we recommend a larger well-randomized, well-controlled, clinical trial to confirm our findings and determine if any significant difference exists between the groups in terms of long-term pain relief and functional restoration. ..
  48. Xiu C, Liu F, Wang H, Wang X, Qu R. [Effects of cardiac sympathetic blockade on left ventricular diastolic function in patients with dilated cardiomyopathy and severe heart failure]. Zhonghua Yi Xue Za Zhi. 2006;86:1170-3 pubmed
    ..Sympathetic blockade reduces the left ventricular cavity and boosts up the ejection performance, thus improving the left ventricular diastolic function. ..
  49. Inoue Y, Nakahara K, Maruyama K, Suzuki Y, Hayashi Y, Kangawa K, et al. Central and peripheral des-acyl ghrelin regulates body temperature in rats. Biochem Biophys Res Commun. 2013;430:278-83 pubmed publisher
  50. Scott Warren J, Hill V, Rajasekaran A. Ganglion impar blockade: a review. Curr Pain Headache Rep. 2013;17:306 pubmed publisher
    ..We review the indications, techniques, and evidence for this pain intervention. ..
  51. Sciuchetti J, Corti F, Ballabio D, Angeli M. Results, side effects and complications after thoracoscopic sympathetic block by clamping. The monza clinical experience. Clin Auton Res. 2008;18:80-3 pubmed publisher
    ..Thoracoscopic sympathecotomy clamping is a successful treatment for hyperhidrosis. Local hyperhydrosis does not reoccur after 17 months, but there is some degree of compensatory hyperhidrosis. ..
  52. Despres G, Veissier I, Boissy A. Effect of autonomic blockers on heart period variability in calves: evaluation of the sympathovagal balance. Physiol Res. 2002;51:347-53 pubmed
    ..VSE, HR, MeanRR and RMSSD were found to be valid indicators of the parasympathetic tone of calves because of large variations due to the drug and low individual variations. No measure reflected the sympathetic tone. ..
  53. Bleckner L, Solla C, Fileta B, Howard R, Morales C, Buckenmaier C. Serum free ropivacaine concentrations among patients receiving continuous peripheral nerve block catheters: is it safe for long-term infusions?. Anesth Analg. 2014;118:225-9 pubmed publisher
    ..The administration of continuous ropivacaine infusions over prolonged time periods, coupled with multiple drug boluses, did not produce toxic or near-toxic serum concentrations. ..