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KMID : 0948920060050020097
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Clinical Pain
2006 Volume.5 No. 2 p.97 ~ p.100
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Intracarpal Tunnel Injection and Cervical Stellate Ganglion Block
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Kim Hee-Sang
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Abstract
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The most common injury of the median nerve is either an acute or chronic compressive lesion referred to as carpal tunnel syndrome (CTS). Women are considerably more prone to the disorder; the female to male ratio range from 3：1 to about 10：1. Risk factors include repetitive activities requiring wrist flexion, wrist extension, or a combination of wrist flexion and extension; hysterectomy without oophorectomy; last menstrual period in menopausal women 6∼12 months ago; relatively short height; over body weight; and crash diets. The treatment of CTS consisted of an intracarpal tunnel injection of triamcinolone 10 mg or other corticosteroid preparations and 1% lidocaine 0.5 ml without epinephrine, followed by wearing a resting hand splint for about 3 weeks. In 76% of such patients, complete symptom relief occurs by 6 weeks. Stellate ganglionic blockade (SGB) with local anesthetics may provide meaningful relief from sympathetically maintained pain (SMP) in the head, neck and upper extremity. If diagnostic block reduces pain, persistent relief can often be achieved from administering a series of local anesthetic injections which is preferred to neurolysis. The patient lies supine with the head slightly lifted forward on a thin pillow and tilted dorsally to stretch the esophagus away from the transverse processes on the left side. The mouth should be slightly opened relax the neck muscles. The trachea and carotid pulse are gently palpated by inserting 2 fingers between the SCM muscle and the trachea to find the most prominent cervical process, C6-the Chassaignac turbercle, which lies at the level of cricoid cartilage. A 22 gauge 1.5 to 2 inch long needle, with a 20 m syringe attached, is advanced trough the skin and underlying tissues until it hits bone, and the needle is withdrawn about 0.5 to 2 mm and fixed. If aspiration test are negative and no sequelae, full dose of local anesthetic slowly is injection. The patient will feel a lump in the throat and may often be temporarily hoarse.
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KEYWORD
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Carpal tunnel syndrome, Stellate ganglionic blockade, Symppathetically maintained pain, Steroid injection, Complex regional pain syndrome
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