Application of Ultrasound-guided Stellate Ganglion Block in Treatment of Allergic Rhinitis

doi:10.37015/AUDT.2023.220008

Abstract

Abstract:

Objectives To assess the clinical efficacy and safety of ultrasound-guided stellate ganglion block in the treatment of allergic rhinitis.

Methods Sixty patients with allergic rhinitis were selected as study subjects and were treated with stellate ganglion blocking. We observed the appearance and time of the patient's Horner syndrome, and compared the patient's clinical symptom scores before and after one month treatment, and calculated the clinical efficacy and overall effective rate.

Results After ultrasound-guided stellate ganglion blocking treatment, 97% of patients occurred Horner syndrome within 2 minutes. The scores of sneezing, runny nose, nasal itching, and nasal congestion significantly reduced at one month after treatment compared with those before treatment, in which there was statistically significant difference (P<0.05). The clinical efficacy rate also reached 96.7% after procedures. No serious complications occurred in this study.

Conclusions Ultrasound-guided stellate ganglion block can significantly improve the clinical symptoms and the life quality for patients with allergic rhinitis, and it is worthy of extensive clinical application.

Key words: Allergic rhinitis; Stellate ganglion blocking; Ultrasound

Chunyao Liu, BS, Huiwen Li, MS, Yajiang Zhang, MS, Ji Liu, BS, Jingru Yang, MS, Wei Li, MS, Jin Gao, BS, Rong Wu, MD. Application of Ultrasound-guided Stellate Ganglion Block in Treatment of Allergic Rhinitis. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(1): 23-27.

Figures/Tables 2

References 31

[1]	Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al. Clinical practice guideline: allergic rhinitis. Otolaryngol Head Neck Surg 2015; 152:S1-S43.
[2]	Wang XY, Ma TT, Wang XY, Zhuang Y, Wang XD, Ning HY, et al. Prevalence of pollen-induced allergic rhinitis with high pollen exposure in grasslands of northern China. Allergy 2018; 73:1232-1243. doi: 10.1111/all.13388 pmid: 29322523
[3]	Wang W, Wang J, Song G, Xie H, Lin X, Chai R, et al. Environmental and sensitization variations among asthma and/or rhinitis patients between 2008 and 2018 in China. Clin Transl Allergy 2022; 12:e12116.
[4]	Meng Y, Wang C, Zhang L. Advances and novel developments in allergic rhinitis. Allergy 2020; 75:3069-3076. doi: 10.1111/all.v75.12
[5]	Gelardi M, Trecca E, Fortunato F, Iannuzzi L, Ronca G, Quaranta N, et al. COVID-19 lockdown and seasonal allergic rhinitis: our experience in 40 patients. Acta Biomed 2021; 92:e2021215.
[6]	Sastre J, Mosges R. Local and systemic safety of intranasal corticosteroids. J Investig Allergol Clin Immunol 2012; 22:1-12.
[7]	Poluzzi E, Raschi E, Godman B, Koci A, Moretti U, Kalaba M, et al. Pro-arrhythmic potential of oral antihistamines (H1): combining adverse event reports with drug utilization data across Europe. PLoS One. 2015; 10:e0119551.
[8]	Bui CM, Chen H, Shyr Y, Joos KM. Discontinuing nasal steroids might lower intraocular pressure in glaucoma. J Allergy Clin Immunol 2005; 116:1042-1047. doi: 10.1016/j.jaci.2005.07.031
[9]	Fei HT, Zhou MT. Evaluation of the effect of stellate ganglion block in the treatment of allergic rhinitis. Journal of Modern Integrative Medicine 2018; 27:987-990. [In Chinese]
[10]	Li DF, Tang WW, Ren XD. Clinical observation on allergic rhinitis treated with three nasal acupuncture combined with stellate ganglion block. Shanghai Journal of Acupuncture and Moxibustion 2019; 38:898-902. [In Chinese]
[11]	Ni J, Zhang QX. Analysis of the effect of stellate ganglion block combined with nasal hormone in the treatment of allergic rhinitis. Xinjiang Medicine, 2021; 51:74-75+90. [In Chinese]
[12]	Goel V, Patwardhan AM, Ibrahim M, Howe CL, Schultz DM, Shankar H. Complications associated with stellate ganglion nerve block: a systematic review. Reg Anesth Pain Med 2019;rapm-2018-100127.
[13]	Narouze S. Ultrasound-guided stellate ganglion block: safety and efficacy. Curr Pain Headache Rep 2014; 18:424. doi: 10.1007/s11916-014-0424-5
[14]	Gunduz OH, Kenis-Coskun O. Ganglion blocks as a treatment of pain: current perspectives. J Pain Res 2017; 10:2815-2826. doi: 10.2147/JPR.S134775 pmid: 29276402
[15]	Zhu G, Kang Z, Chen Y, Zeng J, Su C, Li S. Ultrasound-guided stellate ganglion block alleviates stress responses and promotes recovery of gastrointestinal function in patients. Dig Liver Dis 2021; 53:581-586. doi: 10.1016/j.dld.2020.11.028
[16]	Mulvaney SW, Lynch JH, Hickey MJ, Rahman-Rawlins T, Schroeder M, Kane S, et al. Stellate ganglion block used to treat symptoms associated with combat-related post-traumatic stress disorder: a case series of 166 patients. Mil Med 2014; 179:1133-1140. doi: 10.7205/MILMED-D-14-00151 pmid: 25269132
[17]	Wittwer ED, Radosevich MA, Ritter M, Cha YM. Stellate ganglion blockade for refractory ventricular arrhythmias: implications of ultrasound-guided technique and review of the evidence. J CardiothoracVascAnesth 2020; 34:2245-2252.
[18]	Viswanath O, Aner M. Dramatic extremity temperature increase and Horner's syndrome after stellate ganglion block. Postgrad Med J 2018; 94:237. doi: 10.1136/postgradmedj-2017-135292 pmid: 29343589
[19]	Cheng L, Chen J, Fu Q, He S, Li H, Liu Z, et al. Chinese Society of allergy guidelines for diagnosis and treatment of allergic rhinitis. Allergy Asthma Immunol Res 2018; 10:300-353. doi: 10.4168/aair.2018.10.4.300
[20]	Steelant B, Seys SF, Van Gerven L, Van Woensel M, Farré R, Wawrzyniak P, et al. Histamine and T helper cytokine-driven epithelial barrier dysfunction in allergic rhinitis. J Allergy Clin Immunol 2018; 141:951-963.e8. doi: S0091-6749(17)31622-6 pmid: 29074456
[21]	Lipov E, Gluncic V, Lukić IK, Candido K. How does stellate ganglion block alleviate immunologically-linked disorders? Med Hypotheses 2020; 144:110000. doi: 10.1016/j.mehy.2020.110000
[22]	Yokoyama M, Nakatsuka H, Itano Y, Hirakawa M. Stellate ganglion block modifies the distribution of lymphocyte subsets and natural-killer cell activity. Anesthesiology 2000; 92:109-115. pmid: 10638906
[23]	Yang X, Shi Z, Li X, Li J. Impacts of stellate ganglion block on plasma NF-κB and inflammatory factors of TBI patients. Int J Clin Exp Med 2015; 8:15630-15638. pmid: 26629057
[24]	Yoo Y, Lee CS, Kim YC, Moon JY, Finlayson RJ. A randomized comparison between 4, 6 and 8 ml of local anesthetic for ultrasound-guided stellate ganglion block. J Clin Med 2019; 8:1314. doi: 10.3390/jcm8091314
[25]	Higa K, Hirata K, Hirota K, Nitahara K, Shono S. Retropharyngeal hematoma after stellate ganglion block: analysis of 27 patients reported in the literature. Anesthesiology 2006; 105:1238-6A. doi: 10.1097/00000542-200612000-00024 pmid: 17122587
[26]	Siegenthaler A, Mlekusch S, Schliessbach J, Curatolo M, Eichenberger U. Ultrasound imaging to estimate risk of esophageal and vascular puncture after conventional stellate ganglion block. Reg Anesth Pain Med 2012; 37:224-227. doi: 10.1097/AAP.0b013e31823d40fe pmid: 22157739
[27]	Imani F, Hemati K, Rahimzadeh P, Kazemi MR, Hejazian K. Effectiveness of stellate ganglion block under fuoroscopy or ultrasound guidance in upper extremity CRPS. J Clin Diagn Res 2016; 10:UC09-UC12.
[28]	Gao H, Zhang Z, Guo W, Zhang G. Evaluation of the efficacy and safety of stellate ganglion catheterization and intermittent block in the treatment of sudden deafness. Journal of Clinical Otorhinolaryngology Head and Neck Surgery 2015; 29:1291-1294. [In Chinese]
[29]	Aleanakian R, Chung BY, Feldmann RE Jr, Benrath J. Effectiveness, safety, and predictive potential in ultrasound-guided stellate ganglion blockades for the treatment of sympathetically maintained pain. Pain Pract 2020; 20:626-638. doi: 10.1111/papr.12892 pmid: 32255250
[30]	Yamazaki H, Nishiyama J, Suzuki T. Use of perfusion index from pulse oximetry to determine efficacy of stellate ganglion block. Local Reg Anesth 2012; 5:9-14.
[31]	Ghai A, Kaushik T, Kundu ZS, Wadhera S, Wadhera R. Evaluation of new approach to ultrasound guided stellate ganglion block. Saudi J Anaesth 2016; 10:161-167. doi: 10.4103/1658-354X.168815 pmid: 27051366

Items	Sneeze	Runny nose	Itchy nose	Stuffy nose
Before	2.39 ± 0.66	2.61 ± 0.50	2.61 ± 0.49	2.52 ± 0.59
After	0.52 ± 0.51	0.61 ± 0.49	0.51 ± 0.42	0.57 ± 0.50
t value	12.912	14.227	14.976	25.596
P value	0.001	0.001	0.001	0.001