Efficacy of Stellate Ganglion Blockade Applied with Light Irradiation: A Systemic Review and Meta-analysis.
- From the School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University (C-DL, J-YT); and Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital (C-DL, H-CC, T-HL), Center for Evidence-Based Health Care, Shuang Ho Hospital (H-CC), Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine (H-CC, T-HL), and Graduate Institute of Injury Prevention and Control (T-HL), Taipei Medical University, Taipei, Taiwan.
Stellate ganglion block has mostly been used to relieve symptoms of neuropathic pain; several potential complications have been reported. Noninvasive stellate ganglion block application using light irradiation (SG-LI) can be used as an alternative to conventional injection blockades. Based on the variety of application protocols among previous studies, it was needed to further identify the clinical efficacy of SG-LI in managing neuropathic pain or other disorders associated with sympathetic hyperactivity.
A comprehensive search of online databases was performed to identify experimental or observational studies reporting the efficacy of SG-LI in treating patients with disorders requiring sympatholytic management. The included studies were subjected to a meta-analysis and risk-of-bias assessment.
Twenty-one experimental studies with a Physiotherapy Evidence Database score of 6/10 and 5 observational studies with a Newcastle-Ottawa scale score of 7/9 were included in the analysis. A significant effect on pain relief favoring SG-LI was identified at a standard mean difference (SMD) of -2.05 [95% confidence interval (CI), -2.49 to -1.61; P < 0.00001]. Similar effects favoring SG-LI were found in peripheral blood flow (SMD, 1.26; 95% CI, 0.26-2.25; P = 0.01) and skin temperature (SMD, 1.31; 95% CI, 0.55, 2.08; P = 0.0007).
Stellate ganglion block application using light irradiation effectively relieves pain of various etiologies and successfully induces a sympatholytic response. Stellate ganglion block application using light irradiation may be a valuable addition to the contemporary pain management armamentarium.
J Nippon Med Sch. 2007 Feb;74(1):23-9.
Increases in central retinal artery blood flow in humans following carotid artery and stellate ganglion irradiation with 0.6 to 1.6 micron irradiation.
Mii S, Kim C, Matsui H, Oharazawa H, Shiwa T, Takahashi H, Sakamoto A.
Department of Anesthesiology, Nippon Medical School.
The authors applied near-infrared low-level laser irradiation (LLLI) directed to the stellate ganglion (SG) and to the common carotid artery (CCA), and compared the effects on central retinal artery blood flow using color pulse Doppler sonography. In 10 healthy volunteers, LLLI (0.92 W, 1 : 1 duty cycle, 10 min) to both the SG and CCA significantly increased peak systolic blood velocity in the ophthalmic artery (p<0.001, each) and central retinal artery (p<0.001, each) without changes in vessel resistance. Irradiation to the CCA produced a stronger effect than that to the SG in the ophthalmic artery (p=0.007) and central retinal artery (p=0.031). These data suggest that LLLI to the SG or to the CCA is a useful therapy for increasing the retrobulbar blood flow, with irradiation directed to the CCA being more effective than that directed to the SG in clinical settings.
Photomed Laser Surg. 2006 Feb;24(1):17-21.
Effect of linear polarized light irradiation near the stellate ganglion in skin blood flow of fingers in patients with progressive systemic sclerosis.
Lee CH, Chen GS, Yu HS.
Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan.
OBJECTIVE: The purpose of this study is to evaluate the effect of linear polarized light irradiation near the stellate ganglion area on cutaneous blood flow in fingers of patients with progressive systemic sclerosis. BACKGROUND DATA: Sympathetic overactivity is known to be present in patients with progressive systemic sclerosis. Recently introduced linear polarized light irradiation is designed to simulate noninvasive stellate ganglion block to decrease sympathetic output. METHODS: Five patients with progressive systemic sclerosis and three normal healthy controls were studied. Linear polarized light (Super Lizer) was irradiated near the stellate ganglion on the right side of the neck at 358 J/cm(2) for 10 min. Then, laser Doppler flowmetry, laser Doppler imager, and capillary microscopy were used to measure the cutaneous blood flow of the right fourth finger for 30 min. RESULTS: No significant alternations of the skin blood flow between normal controls and patients with progressive systemic sclerosis after linear polarized light irradiation were detected. The effect of linear polarized light on the microcirculation of patients with progressive systemic sclerosis was minimal and transient. CONCLUSION: The effect of linear polarized light in treating patients with progressive systemic sclerosis may not result from the improvement of skin blood flow. Therefore, the use of linear polarized light in those patients to increase cutaneous blood flow should not be overemphasized.
|Chonnam Med J. 2001 Mar;37(1):49-54. Korean.|
Effects of Stellate Ganglion Irradiation by the Low-level Laser Therapy on Reflex Sympathetic Dystrophy of the Hemiplegic Arm.
Wee JS, Jung JC, Han JY, Lee SG, Rowe SM.
Department of Rehabilitation Medicine, Chonnam National University Medical School, Kwangju, Korea.Research Institute of Medical Sciences, Chonnam National University, Kwangju, Korea.
To evaluate the efficacy of low-level laser therapy (LLLT) on reflex sympathetic dystrophy (RSD) of the hemiplegic arm as an addition to a standardized treatment regimen. Twenty patients were assigned equally to a laser treated limb (LL) and a control limb (CL) group. All pateints received 20-minutes laser irradiation, 5 times weekly for a period of 6 weeks. Follow-up studies were also performed in all patients from the initial stage to the end stage of LLLT. A significant improvement in the LL compared to the CL group was found on visual analog scale (p<0.05), subjective and objective symptoms (p<0.01), swelling in hands (p<0.05) and elevation of body temperature in digital infrared thermal imaging (p<0.01) after 6 weeks. From these results it is inferred that LLLT is an useful method of treatment which is able to reduce the symptom of RSD.; however, as a sole treatment for syndrome of RSD it is of limited value. Further studies are needed to evaluate the reliability of our findings and to compare LLLT to other established treatment methods.
Oral Dis. 2004 Jul;10(4):217-20.
Effects of near-infrared irradiation to stellate ganglion in glossodynia.
Nakase M, Okumura K, Tamura T, Kamei T, Kada K, Nakamura S, Inui M, Tagawa T.
Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Mie University, Tsu, Japan. firstname.lastname@example.org
OBJECTIVE: This study was designed to assess the effect of stellate ganglion near-infrared irradiation (SGR) on glossodynia and the mechanism of action.
STUDY DESIGN: Thirty-seven patients with glossodynia received SGR once weekly for 4 weeks. The response to treatment was evaluated on the basis of the change in pain intensity, assessed with a visual analogue scale (VAS) before and after 4 weeks of treatment. The temperature and blood flow of the tongue were also measured before and after first SGR. As control, eight healthy subjects were studied.
RESULTS: Tongue pain as assessed by the VAS decreased in 28 of the 37 patients (75.7%). Mean pain intensity decreased significantly from 5.1 +/- 2.2 to 1.9 +/- 2.1 (P < 0.05). Tongue blood flow at rest in the patients with glossodynia [7.2 +/- 1.6 ml min(-1) (100 g)(-1)] was significantly lower than that in the healthy subjects [7.8 +/- 0.23 ml min(-1) (100 g)(-1)]. Five minutes after SGR, the temperature of the tongue rose 1.5 +/- 0.21 degrees C, and blood flow increased to 8.5 +/- 1.2 ml min(-1) (100 g)(-1). Tongue blood flow (at rest) after 4 weeks of SGR had increased to 7.7 +/- 1.1 ml min(-1) (100 g)(-1).
CONCLUSION: SGR is an effective treatment for glossodynia. The mechanism by which SGR improves symptoms associated with glossodynia is thought to be as follows: SGR inhibits abnormally increased sympathetic activity associated with glossodynia. This is followed by normalization of decreased tongue blood flow, thereby alleviating pain.
Masui. 2001 Sep;50(9):958-63.
Effects of low reactive level laser, linear polarized light and Xenon-ray irradiation on the stellate ganglion in dogs.
[Article in Japanese]
Nagao M, Yamaguchi S, Okuda Y.
First Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi 321-0293.
The aim of this study was to clarify the influence of low reactive level laser, linear polarized light and Xenon-ray irradiation on stellate ganglion activity in dogs. Under general anesthesia, the right stellate ganglion was exposed by thoracotomy. After stabilization of the hemodynamic parameters, the following baseline measurements were taken: mean arterial pressure (MAP), heart rate (HR), and right brachial artery blood flow (BABF). Experiment 1: The stellate ganglion was directly irradiated for 10 min with low reactive level laser, linear polarized light or Xenon-ray. The hemodynamic parameters were measured for 60 min after each irradiation. Immediately after the irradiation study, stellate ganglion blockade (SGB) with 0.5% mepivacaine 1.0 ml was performed. Experiment 2: After confirming a decrease in BABF by direct electrical stimulation on the stellate ganglion, the stellate ganglion was directly irradiated with low reactive level laser, linear polarized light or Xenon-ray. The hemodynamic parameters were measured for 60 min after each irradiation. Immediately after the irradiation study with 0.5% mepivacaine 1.0 ml was performed. The hemodynamic parameters were also measured for 60 min after SGB. The changes in variables were not statistically significant after each irradiation in the experiment 1 and 2. After SGB, a significant decrease in HR and a significant increase in BABF occurred in the experiment 1 and 2. In conclusion, this study demonstrated that irradiation with low reactive level laser, linear polarized light and Xenon-ray of the stellate ganglion did not induce sympathetic blockade in dogs.
Masui. 1992 Nov;41(11):1809-13.
Low reactive-level laser therapy near the stellate ganglion for postherpetic facial neuralgia
[Article in Japanese]
Ohtsuka H, Kemmotsu O, Dozaki S, Imai M.
Department of Anesthesiology, Hokkaido University School of Medicine, Sapporo.
Low reactive-level laser therapy near the stellate ganglion was given for a 68-year-old female with postherpetic neuralgia, suffering from burning pain in the right forehead for 11 years. Stellate ganglion block and supraorbital nerve block with oral medication were not effective to relieve this pain. The laser irradiation induced warm sensation in her face followed by an excellent pain relief. Thermograms illustrated a remarkable increase from 30.6 degrees C to 31.5 degrees C in temperature of her right face. The irradiation near the right carotid artery also had the similar effect. The results imply that the irradiation with low reactive-level laser of the stellate ganglion and/or the carotid artery increases a facial blood flow and relieves facial neuralgia.
Masui. 1992 Nov;41(11):1814-7.
Polarized light irradiation near the stellate ganglion in a patient with Raynaud’s sign
[Article in Japanese]
Otsuka H, Okubo K, Imai M, Kaseno S, Kemmotsu O.
Department of Anesthesiology, Hokkaido University School of Medicine, Sapporo.
Polarized light irradiation near the stellate ganglion was performed in a 55-year-old female with Raynaud’s sign. She was suffering from cold and numb pain in bilateral fingers for 1 year. Stellate ganglion block and low reactive-level laser therapy near the stellate ganglion were not sufficient to relieve this symptom. Polarized light irradiation near the stellate ganglion induced a sting stimulation and warm sensation in her hands. Thermograms revealed a remarkable increase in temperature of her hands. The results imply that polarized light irradiation near the stellate ganglion increases blood flow of forearms and relieves Raynaud’s sign.
Minerva Med. 1983 Jun 30;74(27):1683-8.
Antiasthma therapy with laser radiation of the stellate ganglia
[Article in Italian]
Bence L, Dussert G.
The authors present a 42-case series of bronchial asthma treated with laser therapy. The technique consists in the use of a diode laser with transcutaneous irradiation projected anteriorly into stellar ganglion. The clinical cases are presented together with the therapeutical results, pointing out how children are more receptive to this therapy and outlining the importance of timing and hour of treatment.