Different Effects of Right and Left Stellate Ganglion Block on Systolic Blood Pressure and Heart Rate

DOI: 10.4236/ojanes.2013.33033   PDF   HTML     4,298 Downloads   6,766 Views   Citations


Purpose: Whether or not right and left stellate ganglion blocks (SGB) affect blood pressure (BP) and heart rate (HR) differently has been controversial. The aim of this study was to analyze BP and HR changes after large numbers of right or left SGBs. Methods: A total of 16,404 right SGBs and 13,766 left SGBs were performed with 6 ml of 1% mepivacaine using the anterior paratracheal approach at C6. Changes in systolic BP and HR 30 min after SGBs were compared to the baseline values. Results: Systolic BP decreased by 25 to 49 mmHg in 10.93% and more than 50 mmHg in 0.67% of 16,404 right SGBs. Those percentages were significantly higher than corresponding percentages; 8.43% and 0.49% of 13,766 left SGBs (P < 0.0001 and P < 0.05, respectively). On the other hand, systolic BP increased by 25-49 mmHg in 5.74% and more than 50 mmHg in 0.52% of left SGBs, and in 4.15% and 0.18% of right SGBs (P < 0.0001and P < 0.0001 between left and right SGBs, respectively). Right SGB caused marked reduction in HR (greater than 30 beats/min), more than left SGB (4.22% versus 2.70%, P < 0.0001). Conclusions: Both right and left SGBs could produce clinically significant hypertension and hypotension, and also severe bradycardia. However, right SGB produces a higher incidence of significant reductions in systolic BP and HR, compared to left SGB. On the other hand, left SGB produces a significant increase in systolic BP compared to right SGB. Those differences likely stem from the hemispheric asymmetry in autonomic cardiovascular control.

Share and Cite:

S. Yokota, C. Taneyama and H. Goto, "Different Effects of Right and Left Stellate Ganglion Block on Systolic Blood Pressure and Heart Rate," Open Journal of Anesthesiology, Vol. 3 No. 3, 2013, pp. 143-147. doi: 10.4236/ojanes.2013.33033.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] M. C. Rogers, G. Battit, B. McPeek and D. Todd, “Lateralization of Sympathetic Control of the Human Sinus Node: ECG Changes of Stellate Ganglion Block,” Anesthesiology, Vol. 48, No. 2, 1978, pp. 139-141. doi:10.1097/00000542-197802000-00009
[2] T. Kashima, H. Tanaka, S. Minagoe and H. Toda, “Electrocardiographic Changes Induced by the Stellate Ganglion Block in Normal Subjects,” Journal of Electrocardiology, Vol. 14, No. 2, 1981, pp. 169-174. doi:10.1016/S0022-0736(81)80052-0
[3] J. S. Goh, B. W. Min and H. D. Kim, “Blood Pressure, Pulse Rate and Temperature Changes of the Ipsilateral Upper Extremity after Unilateral Stellate Ganglion Block,” Journal of Korean Pain Society, Vol. 3, No. 1, 1990, pp. 27-33.
[4] M. J. Gardner, S. Kimber, D. E. Johnstone, R. C. Shukla, B. M. Horacek, C. Forbes and J. A. Armour, “The Effects of Unilateral Stellate Ganglion Blockade on Human Cardiac Function during Rest and Exercise,” Journal of Cardiovasc Electrophysiology, Vol. 4, No. 1, 1993, pp. 2-4. doi:10.1111/j.1540-8167.1993.tb01207.x
[5] E. B. Lobato, K. B. Kern, G. B. Paige, M. Brown and C. A. Sulek, “Differential Effects of Right versus Left Stellate Ganglion Block on Left Ventricular Function in Humans: An Echocardiographic Analysis,” Journal of Clinical Anesthesia, Vol. 12, No. 4, 2000, pp. 315-318. doi:10.1016/S0952-8180(00)00158-6
[6] T. Kimura, K. Nishiwaki, S. Yokota, T. Komatsu and Y. Shimada, “Severe Hypertension after Stellate Ganglion Block,” British Journal of Anaesthesia, Vol. 94, No. 6, 2005, pp. 840-842. doi:10.1093/bja/aei134
[7] C. Taneyama and H. Goto, “Fractal Cardiovascular Dynamics and Baroreflex Sensitivity after Stellate Ganglion Block,” Anesthesia & Analgesia, Vol. 109, No. 4, 2009, pp. 1335-1340. doi:10.1213/ane.0b013e3181b018d8
[8] H. G. Yu, H. Chung, K. W. Yoon and H. J. Kim, “Stellate Ganglion Block Increases Blood Flow into the Optic Nerve Head and the Peripapillary Retina in Human,” Autonomic Neuroscience, Vol. 109, No. 1-2, 2003, pp. 53-57. doi:10.1016/j.autneu.2003.08.010
[9] T. Kawada, K. Uemura, K. Kashihara, Y. Jin, M. Li, C. Zheng, M. Sugimachi and K. Sunagawa, “Uniformity in Dynamic Baroreflex Regulation of Left and Right Cardiac Sympathetic Nerve Activities,” American Journal of Physiology. Regulatory, Integrative and Comparative Physiology, Vol. 284, No. 6, 2003, pp. R1506-R1512.
[10] K. Yokoyama and K. Sugiyama, “Hemodynamic Effects of Stellate Ganglion Block: Analysis Using a Model of Aortic Input Impedance,” Canadian Journal of Anesthesia, Vol. 49, No. 8, 2002, pp. 887-888. doi:10.1007/BF03017432
[11] M. Guntumukkala and P. A. Hardy, “Spread of Injectate after Stellate Ganglion Block in Man: An Anatomical Study,” British Journal of Anaesthesia, Vol. 66, No. 6, 1991, pp. 643-644. doi:10.1093/bja/66.6.643
[12] T. Ikeda, S. Iwase, Y. Sugiyama, T. Matsukawa, T. Mano, M. Doi, M. Kikura and K. Ikeda, “Stellate Ganglion Block Is Associated with Increased Tibial Nerve Muscle Sympathetic Activity in Humans,” Anesthesiology, Vol. 84, No. 4, 1996, pp. 843-850. doi:10.1097/00000542-199604000-00011
[13] M. J. Hilz, M. Dutsch, K. Perrine, P. K. Nelson, U. Rauhut and O. Devinsky, “Hemispheric Influence on Autonomic Modulation and Baroreflex Sensitivity,” Annals of Neurology, Vol. 49, No. 5, 2001, pp. 575-578. doi:10.1002/ana.1006
[14] W. Wittling, A. Block, S. Genzel and E. Schweiger, “Hemispheric Asymmetry in Parasympathetic Control of the Heart,” Neuropsychologia, Vol. 36, No. 5, 1998, pp. 461-468. doi:10.1016/S0028-3932(97)00129-2
[15] B. W. Yoon, C. A. Morillo, D. F. Cechetto and V. Hachinski, “Cerebral Hemispheric Lateralization in Cardiac Autonomic Control,” Archives of Neurology, Vol. 54, No. 6, 1997, pp. 741-744. doi:10.1001/archneur.1997.00550180055012
[16] D. S. Shannahoff-Khalsa, “Selective Unilateral Autonomic Activation: Implications for Psychiatry,” CNS Spectrums, Vol. 12, No. 8, 1997, pp. 625-634.

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.