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A 56-year-old woman had been treated with stellate ganglion block (SGB) for pigmentation degeneration retinopathy over 6 years. She had no history of diabetes mellitus or immunodeficiency. She complained of high back pain but was afebrile. She was diagnosed as pyogenic osteomyelitis by the MRI findings and hematological examination. Antibiotics was administerd for 3 weeks and inflammatory signs disappeared. We should bear in mind that pyogenic osteomyelitis is very rare but one of the most serious complications with SGB.

We report here a case of paraplegia following coeliac plexus block by anterior approach under direct vision. Laparotomy was performed in a 62-year-old male patient with pancreatic cancer. Coeliac plexus block was undertaken in order to control his back pain, since the tumor was unresectable. The patient complained of numbness and weakness of his legs 14 hours later. The consequence of neurological events was diagnosed as ischemic infarct of the spinal cord by myelo-CT and MRI. He died of pancreatic cancer without recovery of neurological disturbances 4 months after the surgery. As demonstrated in this case, even when coeliac plexus block was performed by open anterior approach under direct vision, paraplegia might be a possible complication due to the anatomical proximity of coeliac plexus to the Adamkiewicz's artery.

We report a case of severe hypertension following stellate ganglion block. A 61-year old woman received the left stellate ganglion block with 5 ml of 1% mepivacaine for her left facial palsy. Before the stellate ganglion block, blood pressure was 120/68 mmHg and heart rate was 62 b.p.m. Seven minutes after the left stellate ganglion block, blood pressure increased to 230/140 mmHg, but heart rate was unchanged. Systolic blood pressure remained above 190 mmHg for 60 minutes following the stellate ganglion block. We suggest that the extreme increase in blood pressure was due to the vagal nerve block associated with the left stellate ganglion block.

We experienced a case of sinus arrest probably induced by right stellate ganglion block (SGB). A healthy medical student volunteered in our study of the cardiac autonomic nervous system and received the SGB. After the Holter ECG had been attached, the SGB was performed with mepivacaine 8 ml. Horner's sign was observed after about 3 minutes. A transient (15 s) sinus arrest occurred suddenly after about 6 minutes of the tilt test probably due to a vasovagal reflex, and the subject lost consciousness. From spectral analysis of the Holter ECG recording, the right SGB may be closely involved in the induction of the sinus arrest. Our present case suggests that sinus arrest may occur if a patient stands up after right SGB.

We evaluated the effect of intraoperative celiac plexus block (CPB) and thoracic epidural block (TEB) on arterial ketone body ratio (AKBR) in the patients undergoing total or partial gastrectomy. Mean arterial pressure (MAP), heart rate, AKBR, and arterial blood gas were measured at the end of esophago-jejunostomy, gastro-duodenostomy, or gastro-jejunostomy (pre-block) and at the end of operation (post-block), respectively. After pre-block measurement, CPB with 99.5% ethanol 15-20 ml was carried out in 8 patients with advanced gastric cancer (CPB group); TEB with 2% lidocaine was performed on 8 patients (TEB group); and neither CPB nor TEB was done on 8 patients (control group). A significant reduction in MAP was observed after CPB and TEB. There was no difference in the degree of MAP decrease between CPB group and TEB group. No change in MAP was observed in control group. In CPB group significant decreases in AKBR, pH, and BE were induced by CPB. However, there were no difference in AKBR, pH, and BE between pre-block values and post-block values in TEB group as in the control group. These findings suggest that ethanol used in CPB reduces the redox state of hepatic mitochondria and increases lactate. Therefore we should pay attention to the changes in AKBR, pH, and BE after celiac plexus block with ethanol.

We attempted to define effects of stellate ganglion block (SGB) at the base of 6th cervical transverse process by evaluating extent and degree of sympathetic blockade after SGB using the infrared thermography. Ten healthy volunteers (7 females, 3 males, age 26.0 years) were subjects of this study. Two different volumes (5 or 10 ml) of 1% plain mepivacaine were used (B5 group and B10 group). We performed SGB twice using two different volumes in all subjects on different day. Thermography was performed before and 30 minutes after SGB. On thenar and hypothenar, change of skin temperature in the B10 group tended to be higher compared with the B5 group. There were no significant differences in forehead or cheek temperature between the two groups. The thermographic whole hot area pattern on the ipsilateral hand after SGB in B10 group (60%) tended to be more frequent compared with the B5 group (40%). All subjects showed Horner's sign. No severe side-effect occurred in either group, but complaints of dysphagia appeared more frequently in the B10 group (80%) than in B5 group (40%). The change of skin temperature on thenar and hypothenar after B5 was significantly larger than that after the SGB at the top of the anterior tubercle of 6th cervical transverse process (P less than 0.05). In conclusion, B10 had more effect on lower cervical and upper thoracic sympathetic nerves than B5, but it also had a significant incidence of dysphagia feeling. Concerning the effect of the lower cervical and upper thoracic sympathetic block, B5 was superior to the SGB at the top of the anterior tubercle of 6th cervical transverse process.