The magical stellate ganglion - the human body's comfort switch

Keywords: comfort; switch; stellate ganglion block; ultrasound; treatment

Abstract: Modern people are generally facing great pressure, which mainly comes from many factors such as work, study, life, and family. These pressures may cause symptoms such as headaches, dizziness, insomnia, and anxiety, causing discomfort in all aspects of the human body. There is a tiny neural network intersection on both sides deep in the human neck. Although it looks inconspicuous, it is the "switch" that controls the comfort of the human body and manages common diseases and symptoms related to all people. It has an important regulatory effect on the autonomic nervous function of the human body [1]. The autonomic nervous system includes sympathetic nerves and parasympathetic nerves, which are responsible for the daytime and nighttime states of the human body respectively. Under normal circumstances, the sympathetic and parasympathetic nerves perform their respective duties without affecting each other, and jointly regulate the various physiological functions of the human body. However, when a lot of pressure or negative emotions accumulate for a long time, our nerves will be in a tense state, which will cause the autonomic nervous function to be disordered, thereby affecting the comfort of the human body. By blocking and regulating the switch (stellate ganglion), it can quickly restore its normal vitality.

The amazing stellate ganglion

When we are faced with a lot of pressure or negative emotions that cannot be relieved for a long time, it will cause discomfort in various parts of our body. At this time, we need a "switch" to play a role in regulation, and this switch is the stellate ganglion, which is hidden on both sides of our neck. Of course, you can't touch it. We need professional ultrasound equipment to see it. Because its appearance resembles "stars" under ultrasound images, it is called stellate ganglion.

It belongs to the sympathetic nervous system. You may be curious about what the sympathetic nervous system is. In fact, there are two major generals in our body, namely the sympathetic nervous system and the parasympathetic nervous system. They belong to the autonomic nervous system. When the sympathetic nervous system is excited, it is like a lively boy, full of energy and high excitement, as if you have endless energy. At this time, your breathing is rapid, your eyes are big, your heart is pounding, and even the hairs on your body are standing up. The parasympathetic nervous system is like a gentle masseur. When we are ready to fall asleep, the parasympathetic nervous system will slow down our heartbeat, slow our breathing, relax our whole body, and gradually enter a state of relaxation and rest, as if we are free and easy in a dream. Under normal circumstances, the sympathetic and parasympathetic nervous systems with opposite functions balance and restrict each other [2]. There is a relationship of mutual confrontation and cooperation between the two, forming a pair of twin sisters that cooperate well, so that our body can cope with joy, anger, sorrow and happiness well and always be full of vitality.

Why is it so magical? Because it not only regulates the activity of people's eye muscles, controls the dilation and shrinkage of pupils, and manages the amount of sweat secretion, but also regulates the depth of our sleep, manages endocrine, heart beats, vasodilation and other important physiological activities, and plays a connecting role in the body. It can be said that it is hidden and has great responsibilities. In fact, it is also an automatic neuroendocrine traffic hub, which is not controlled by the human brain headquarters. As the saying goes, a general is not subject to military orders when he is away; it can also control the function of blood vessels and nerves by itself. By repeatedly stimulating it, it can play a feedback regulation role in the nerves, blood vessels, and endocrine networks in various parts of the body [3, 4, 5]. This is also the reason why it is so magical.

Advantages of ultrasound compared to conventional stellate ganglion block

Traditional stellate ganglion block often requires manual compression of the neck and separation of the jugular artery and vein. The patient has a strong sense of suffocation. In addition, repeated blind punctures to find bone landmarks can easily make the patient nervous, and the puncture experience is poor. The dosage of medication is large and there are many side effects. Therefore, it is not suitable for widespread clinical promotion.

The advantages of ultrasound are mainly reflected in 1. Safety: ultrasound-guided stellate ganglion block therapy can be performed under real-time monitoring, clearly showing the puncture path and depth, and avoiding damage to surrounding important tissues, such as the carotid artery, vagus nerve, thyroid, supraclavicular artery, pulmonary apex, vertebral artery, recurrent laryngeal nerve, etc. 2. Accuracy: Ultrasound guidance can accurately display the location of the stellate ganglion, ensuring that the drug is accurately injected into the target area, improving the treatment effect and reducing the occurrence of complications. 3. Minimally invasive: Ultrasound-guided stellate ganglion block therapy does not require surgery and can be performed by injection. Postoperative recovery is fast and pain is mild[5].

Ultrasound-guided stellate ganglion block procedure

Ultrasound is the third eye of modern doctors. After the pre-operation education, the doctor will disinfect your neck skin, and then use a puncture needle as thin as a hair to accurately select the puncture route under the guidance of ultrasound, and monitor the puncture path and depth in real time. The doctor will skillfully avoid important tissues such as adjacent blood vessels, nerves and pleura. When the puncture needle reaches the target, the doctor will accurately inject the therapeutic drug around the nerve. This treatment process takes about 1 minute, and the therapeutic drug is mainly local anesthetic, without other complex ingredients. This treatment method greatly reduces the risk and makes you safer and more comfortable during the treatment process. See Figures (1, 2)

Figure 1

Figure 2

Figure 3

2-3 minutes after treatment, blurred vision, bloodshot eyes, slightly sunken eyeballs, blocked nasal passages, ruddy face, slight fever, and sometimes a sense of dizziness appear on the treated side. These symptoms are normal manifestations of the drug taking effect and should not be too worrying. They will return to normal in about 40 minutes. In order to achieve a good clinical treatment effect, when receiving stellate ganglion block therapy, it is usually necessary to alternate between left and right treatments. A course of treatment is 6-10 times. Depending on the condition, the number of treatments can be increased or decreased as appropriate. See Figure (3)

Indications and contraindications of stellate ganglion block therapy

Stellate ganglion block therapy is a widely used treatment method in clinical practice, which is said to be able to cure all diseases; its main indications include: 1. Head diseases: such as various types of migraine, cerebral vasospasm, facial neuritis, vertigo, mandibular joint disorder syndrome, etc. 2. Systemic diseases: such as hypertension, hypothyroidism, anorexia, myasthenia gravis, chronic fatigue syndrome, etc. 3. Diseases of the five sense organs: such as sudden deafness and tinnitus, allergic rhinitis, floaters, oral ulcers, Meniere's syndrome, etc. 4. Respiratory system diseases: such as bronchial asthma, bronchospasm, chronic obstructive pulmonary disease, etc. 5. Circulatory system diseases: such as angina pectoris, myocardial infarction, arrhythmia, etc. 6. Visceral diseases: such as diseases of the heart, trachea, stomach, intestines, etc. 7. Urogenital system diseases: such as neurogenic frequent urination, infertility, dysmenorrhea, etc. 8. Diseases of the body and limbs: such as cervical spondylosis, lumbar spondylosis, arthritis, etc. 9. Pain treatment: such as trigeminal neuralgia, glossodynia, oral mucosal dryness, etc. 10. Neurodermatitis, skin itching, chronic fatigue syndrome, etc. caused by endocrine disorders [6,7].

The main contraindications include infection, bleeding, thrombosis at the puncture site, congenital neurological defects, neuropathy and tumors, and those with mental disorders who cannot cooperate. In addition, pregnancy is also a relative contraindication for stellate nerve block, which may have adverse effects on the fetus.

In conclusion, ultrasound-guided cervical stellate ganglion block is a safe, effective, quick, and minimally invasive treatment method. However, it should be noted that any treatment has its indications and contraindications and cannot be achieved overnight. Therefore, when considering stellate ganglion block treatment, be sure to follow the advice of a professional doctor and make sure you choose a treatment plan that suits you.

References:

[1] Wang Le, Liu Beilei, Wu Gang. Stellate ganglion and cardiovascular disease?[J]. Chinese Journal of Cardiac Pacing and Electrophysiology, 2018, 32(6): 592-594.
DOI:10.13333/j.cnki.cjcpe.2018.06.018.

[2] Su Yang. Study on the effect of electroacupuncture at Neiguan point in treating atrial fibrillation and regulating the balance of autonomic nervous activity[D]. Guangdong: Guangzhou University of Chinese Medicine, 2022.

[3] Jin Luwei, Zou Xuejun. Research progress of stellate ganglion block for disease treatment[J]. Chinese Journal of Anesthesiology, 2022, 42(6):766-768.
DOI:10.3760/cma.j.cn131073.20220117.00629.

[4] Wang Jianhua, Gao Shuqin, Bao Caiyun, et al. Clinical efficacy of cervical muscle balance regulation and training combined with ultrasound-guided stellate ganglion block in the treatment of hypertension caused by sympathetic cervical spondylosis[J]. Journal of Practical Cardiovascular, Cerebrovascular and Pulmonary Diseases, 2021, 29(9): 116-121.
DOI:10.12114/j.issn.1008-5971.2021.00.195.

[5] Li Xiukun, Liu Lei, Sui Mingwei. Research progress of ultrasound-guided stellate ganglion block[J]. Chinese Journal of Laboratory Diagnosis, 2020, 24(11): 1913-1915.
DOI:10.3969/j.issn.1007-4287.2020.11.047.

[6] Li Jing. Clinical efficacy of acupuncture combined with ultrasound-guided stellate ganglion block in the treatment of peripheral facial paralysis[D]. Hubei: Hubei University of Traditional Chinese Medicine, 2023.

[7] Ning Feihong, He Ying, Zhu Lili, et al. Clinical study of ultrasound-guided stellate ganglion combined with brachial plexus block in the treatment of cervical and shoulder syndrome[J]. Journal of Cervical and Lumbar Pain, 2023, 44(6): 955-957.
DOI:10.3969/j.issn.1005-7234.2023.06.013.

Funding project: Shanghai Jing'an District Health Research Project General Project Project No.: 2022MS06

Project Title: Clinical study on relieving migraine in patients with insomnia by using cervical ultrasound-guided stellate ganglion block

Project leader: Liu Meiyue

Author: Liu Meiyue, Department of Anesthesiology, Zhabei Central Hospital, Jing'an District, Shanghai

Corresponding author: Zhang Qing

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