Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-25T06:13:03.463Z Has data issue: false hasContentIssue false
  • English
  • Français

Stellate ganglion block inhibits formalin-induced nociceptive responses: mechanism of action

Published online by Cambridge University Press:  25 November 2005

Q. X. Wang ,
X. Y. Wang ,
N. A. Fu ,
J. Y. Liu  and
S. L. Yao
Q. X. Wang
Affiliation:
People's Hospital, P. R. China Huazhong University of Science and Technology Tongji Medical School, Union Hospital, Department of Anesthesiology, Wuhan, P. R. China
X. Y. Wang
Affiliation:
Taihe Hospital, Yunyang Medical College, Department of Anesthesiology, Shiyan, P. R. China
N. A. Fu
Affiliation:
Taihe Hospital, Yunyang Medical College, Department of Anesthesiology, Shiyan, P. R. China
J. Y. Liu
Affiliation:
Taihe Hospital, Yunyang Medical College, Department of Anesthesiology, Shiyan, P. R. China
S. L. Yao
Affiliation:
Huazhong University of Science and Technology Tongji Medical School, Union Hospital, Department of Anesthesiology, Wuhan, P. R. China
Get access

Extract

Summary

Background and objective: Stellate ganglion block has been extensively used in clinical practice for the management of painful conditions such as cephalic, facial and upper limb pains yet its mechanism of action and its analgesic efficacy are poorly understood. Method: Formalin (3% 0.2 mL) was injected into the plantar region of the right upper limb paw in rabbits and 50 min after this injection, saline or bupivacaine 2.5% 0.5 mL was administered via a chronic implantation catheter near the right stellate ganglion. Behavioural modification, changes in heart rate and plasma norepinephrine release at different time points after formalin and bupivacaine or saline injection were observed. Finally, the cervical spinal cord was harvested and immunostaining for substance P and c-Fos was performed. Results: Formalin caused stress noxious behavioural changes and a significant increase in heart rate and norepinephrine release. These changes were inhibited by bupivacaine stellate ganglion block but not by saline injection. Immunoreactants of substance P were significantly decreased by formalin injection compared with that in controls. However, with bupivacaine injection, substance P levels were restored though not reaching the levels seen in the controls. Formalin injection also caused a significant increase of c-Fos expression in cervical spinal cord. This increase was not affected by stellate ganglion block. Conclusion: Stellate ganglion block can effectively alleviate nociceptive responses induced by formalin injection. The mechanism of its action may involve reduction of substance P in the spinal cord and plasma catecholamine release caused by noxious stimuli.

Keywords

ANAESTHETIC TECHNIQUE, stellate ganglion blockRABBITLOCAL ANAESTHETICS, bupivacaineCATECHOLAMINES, norepinephrineSUBSTANCE P
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 12 , December 2005 , pp. 913 - 918
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Koyama S, Sato N, Nagashima K et al. Effects of right stellate ganglion block on the autonomic nervous function of the heart: a study using the Head-up Tilt Test. Circ J 2002; 66: 645–648.Google Scholar
Schürmann M, Gradl G, Wizgal I et al. Clinical and physiologic evaluation of stellate ganglion blockade for complex regional pain syndrome Type I. Clin J Pain 2001; 17: 94–100.Google Scholar
Parris WCV, Lin S, Frist W. Use of stellate ganglion block for chronic chest pain associated with primary pulmonary hypertention. Anesth Analg 1988; 67: 993–995.Google Scholar
Hogan QH, Abram SE. Neural blockade for diagnosis and prognosis: a review. Anesthesiology 1997; 86: 216–241.Google Scholar
Powell KJ, Quirion R, Jhamandas K. Inhibition of neurokinin-1-substance P receptor and prostanoid activity prevents and reverses the development of morphine tolerance in vivo and the morphine-induced increase in CGRP expression in cultured dorsal root ganglion neurons. Eur J Neurosci 2003; 18: 1572–1583.Google Scholar
Gilron I, Quirion R, Coderre TJ. Pre- vs. postformalin effects of ketamine or large-dose alfentanil in the rat: discordance between pain behavior and spinal fos-like immunoreactivity. Anesth Analg 1999; 89: 128–135.Google Scholar
Kinnman E, Levine JD. Involvement of the sympathetic postganglionic neuron in capsaicin-induced secondary hyperalgesia in the rat. Neuroscience 1995; 65: 283–291.Google Scholar
Kinnman E, Nygards EB, Hansson P. Peripheral α-adrenoreceptors are involved in the development of caspsaicin-induced ongoing and stimulus evoked pain in human. Pain 1997; 69: 79–85.Google Scholar
Drummond PD. Noradrenaline increases hyperalgesia to heat in skin sensitised by capsaicin. Pain 1995; 60: 311–315.Google Scholar
Drummond PD. Enhancement of thermal hyperalgesia by alpha-adrenoceptors in capsaicin-treated skin. J Auto Nerv Syst 1998; 69: 96–102.Google Scholar
Dorazil-Dudzik M, Mika J, Schafer MKH et al. The effects of local pentoxifylline and propentofylline treatment on formalin-induced pain and tumor necrosis factor-[alpha] messenger RNA levels in the inflamed tissue of the rat paw. Anesth Analg 2004; 98: 1566–1573.Google Scholar
McDonald JS, Pensak ML, Phero JC. Part II: thoughts on the management of chronic facial, head, and neck pain. Am J Oncol 1990; 11: 378–382.Google Scholar
Suzuki H, Yoshioka K, Maehara T et al. Differential effects of wortmannin on the release of substance P and amino acids from the isolated spinal cord of the neonatal rat. Br J Pharmacol 1998; 125: 1661–1668.Google Scholar
Kuraishi Y, Hirota N, Sato Y et al. Evidence that substance P and somatostatin transmit separate information related to pain in the spinal dorsal horn. Brain Res 1985; 325: 294–298.Google Scholar
Ruan HZ, Li XC, Cai WQ. Effect of 5-HT on pain modulation of substance P in spinal cord of rats. Zhongguo Yao Li Xue Bao 1995; 16: 512–516.Google Scholar
Duggan AW, Hendry IA, Morton CR et al. Cutaneous stimuli releasing immunoreactive substance P in the dorsal horn of the cat. Brain Res 1988; 451: 261–273.Google Scholar
Regoli D, Drapeau G, Dion S, D'Orleans JP. Receptors for substance P and related neurokinins. Pharmacology 1989; 38: 1–15.Google Scholar
Polgar E, Szucs P, Urban L, Nagy I. Alterations of substance P immunocreativity in lumbar and thoratic segments of rat spinal cord in ultraviolet irradiation induced hyperalgesia of the hind paw. Brain Res 1998; 786: 248–251.Google Scholar
Raja SN. Role of the sympathetic nervous system in acute pain and inflammation. Ann Med 1995; 27: 241–246.Google Scholar
Janig W, Habler HJ. Sympathetic nervous system: contribution to chronic pain. Brain Res 2000; 129: 451–468.Google Scholar
Ren Y, Zou X, Fang L, Lin Q. Sympathetic modulation of activity in Aδ and C primary nociceptive afferents following intradermal injection of capsaicin in rats. J Neurophysiol 2004; 15 (Epub ahead of print).Google Scholar
Yokoyama M, Nakatsuka H, Itano Y, Hirakawa M. Stellate ganglion block modifies the distribution of lymphocyte subsets and natural-killer cell activity. Anesthesiology 2000; 92: 109–115.Google Scholar
Torebjork E, Wahren L, Wallin G, Hallin R, Koltzenburg M. Noradrenaline-evoked pain in neuralgia. Pain 1995; 63: 11–20.Google Scholar
Li XQ, Clark JD. Hyperalgesia during opioid abstinence: mediation by glutamate and substance P. Anesth Analg 2002; 95: 979–984.Google Scholar
Zhang GH, Min SS, Lee KS et al. Intraarticular pretreatment with ketamine and memantine could prevent arthritic pain: relevance to the decrease of spinal c-Fos expression in rats. Anesth Analg 2004; 99: 152–158.Google Scholar
Kingery WS, Agashe GS, Sawamura S et al. Glucocorticoid inhibition of neuropathic hyperalgesia and spinal fos expression. Anesth Analg 2001; 92: 476–482.Google Scholar