Associazione Nazionale Medici Cardiologi Ospedalieri




Giuranna Marco Perugia(PG) – Ospedale Santa Maria della Misericordia | Freschini Manuel Perugia(PG) – Ospedale Santa Maria della Misericordia | Notaristefano Francesco Perugia(PG) – Ospedale Santa Maria della Misericordia

70-year-old man with chronic coronaric syndrome (CABG x 6 in 2006) and HFrEF. ICD implant in primary prevention in 2011. He was admitted for arrhythmic storms refractory to IV lidocaine therapy. Following sedation with midazolam, a left stellate ganglion block was performed using the ultrasound-guided lateral approach, injecting 200 mg of Lidocaine and 200 mg of Mepivacaine. After a few minutes, there was the appearance of anisocoria, different thermotouch in the upper limbs, ptosis, dysphonia, as an effect of local anesthetics on the sympathetic nervous system fibers and on the recurrent laryngeal nerve, near the stellate ganglion. At the same time, the arrhythmias did not recur.

Among the rare complications described in the literature (usually transient) arising after stellate ganglion block for the treatment of various chronic pain syndromes or refractory ventricular arrhythmias, we find: hoarseness, stridor, confusion, cough, severe hypertension, subdural/intrathecal block with respiratory arrest, loss of consciousness and paralysis of the four limbs, epileptic seizures, transient locked-in syndrome, headache, visual hallucinations, myoclonus, Horner ‘s syndrome, diaphragmatic palsy (phrenic nerve injury), allergic reactions, bleeding and hematoma formation, dural puncture, pneumothorax, local infections.

Serious adverse effects described include cases of death or tetraplegia following epidural abscess. For this reason, it is of utmost importance monitoring after the procedure and the availability of the equipment necessary for a possible resuscitation to avoid long-term of sequelae.

Conclusion: in cases of arrhythmic storm refractory to antiarrhythmic therapy, percutaneous stellate ganglion block is an effective and safe procedure and serious complications are rare.