PDF(Pubmed)
Abstract：
OBJECTIVE: Percutaneous stellate ganglion block (PSGB) through single-bolus injection and thoracic epidural anaesthesia (TEA) have been proposed for the acute management of refractory ventricular arrhythmias (VAs). However, data on continuous PSGB (C-PSGB) are scant. The aim of this study is to report our dual-centre experience with C-PSGB and to perform a systematic review on C-PSGB and TEA.
RESULTS: Consecutive patients receiving C-PSGB at two centres were enrolled. The systematic literature review follows the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Our case series (26 patients, 88% male, 60 ± 16 years, all with advanced structural heart disease, left ventricular ejection fraction 23 ± 11%, 32 C-PSGBs performed, with a median duration of 3 days) shows that C-PSGB is feasible and safe and leads to complete VAs suppression in 59% and to overall clinical benefit in 94% of cases. Overall, 61 patients received 68 C-PSGBs and 22 TEA, with complete VA suppression in 63% of C-PSGBs (61% of patients). Most TEA procedures (55%) were performed on intubated patients, as opposed to 28% of C-PSGBs (P = 0.02); 63% of cases were on full anticoagulation at C-PSGB, none at TEA (P < 0.001). Ropivacaine and lidocaine were the most used drugs for C-PSGB, and the available data support a starting dose of 12 and 100 mg/h, respectively. No major complications occurred, yet TEA discontinuation rate due to side effects was higher than C-PSGB (18 vs. 1%, P = 0.01).
CONCLUSIONS: Continuous PSGB seems feasible, safe, and effective for the acute management of refractory VAs. The antiarrhythmic effect may be accomplished with less concerns for concomitant anticoagulation compared with TEA and with a lower side-effect related discontinuation rate.
RESULTS: Consecutive patients receiving C-PSGB at two centres were enrolled. The systematic literature review follows the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Our case series (26 patients, 88% male, 60 ± 16 years, all with advanced structural heart disease, left ventricular ejection fraction 23 ± 11%, 32 C-PSGBs performed, with a median duration of 3 days) shows that C-PSGB is feasible and safe and leads to complete VAs suppression in 59% and to overall clinical benefit in 94% of cases. Overall, 61 patients received 68 C-PSGBs and 22 TEA, with complete VA suppression in 63% of C-PSGBs (61% of patients). Most TEA procedures (55%) were performed on intubated patients, as opposed to 28% of C-PSGBs (P = 0.02); 63% of cases were on full anticoagulation at C-PSGB, none at TEA (P < 0.001). Ropivacaine and lidocaine were the most used drugs for C-PSGB, and the available data support a starting dose of 12 and 100 mg/h, respectively. No major complications occurred, yet TEA discontinuation rate due to side effects was higher than C-PSGB (18 vs. 1%, P = 0.01).
CONCLUSIONS: Continuous PSGB seems feasible, safe, and effective for the acute management of refractory VAs. The antiarrhythmic effect may be accomplished with less concerns for concomitant anticoagulation compared with TEA and with a lower side-effect related discontinuation rate.
摘要：
目的：通过单次推注和胸段硬膜外麻醉（TEA）的经皮星状神经节阻滞（PSGB）已被建议用于难治性室性心律失常（VA）的急性治疗。然而,连续PSGB(C-PSGB)上的数据很少。这项研究的目的是报告我们在C-PSGB的双中心经验，并对C-PSGB和TEA进行系统审查。
结果：纳入两个中心连续接受C-PSGB的患者。系统文献综述遵循系统评价和荟萃分析(PRISMA)标准的最新首选报告项目。我们的病例系列(26名患者，88%男性，60±16岁,都患有晚期结构性心脏病，左心室射血分数23±11%，执行32个C-PSGB，中位持续时间为3天）表明C-PSGB是可行且安全的，并导致59％的完全VAs抑制和94％的病例的总体临床获益。总的来说,61例患者接受了68例C-PSGBs和22例TEA，在63％的C-PSGBs（61％的患者）中完全抑制VA。大多数TEA手术（55％）是在插管的患者中进行的，与28%的C-PSGB(P=0.02)相反；63%的病例在C-PSGB接受完全抗凝治疗，TEA无（P<0.001）。罗哌卡因和利多卡因是C-PSGB最常用的药物，现有数据支持12和100毫克/小时的起始剂量，分别。无重大并发症发生,然而，由于副作用导致的TEA停药率高于C-PSGB(18vs.1%,P=0.01）。
结论：连续PSGB似乎可行，安全,对难治性VAs的急性管理有效。与TEA相比，可以实现抗心律失常作用，而对伴随抗凝的关注较少，并且与副作用相关的停药率较低。
结果：纳入两个中心连续接受C-PSGB的患者。系统文献综述遵循系统评价和荟萃分析(PRISMA)标准的最新首选报告项目。我们的病例系列(26名患者，88%男性，60±16岁,都患有晚期结构性心脏病，左心室射血分数23±11%，执行32个C-PSGB，中位持续时间为3天）表明C-PSGB是可行且安全的，并导致59％的完全VAs抑制和94％的病例的总体临床获益。总的来说,61例患者接受了68例C-PSGBs和22例TEA，在63％的C-PSGBs（61％的患者）中完全抑制VA。大多数TEA手术（55％）是在插管的患者中进行的，与28%的C-PSGB(P=0.02)相反；63%的病例在C-PSGB接受完全抗凝治疗，TEA无（P<0.001）。罗哌卡因和利多卡因是C-PSGB最常用的药物，现有数据支持12和100毫克/小时的起始剂量，分别。无重大并发症发生,然而，由于副作用导致的TEA停药率高于C-PSGB(18vs.1%,P=0.01）。
结论：连续PSGB似乎可行，安全,对难治性VAs的急性管理有效。与TEA相比，可以实现抗心律失常作用，而对伴随抗凝的关注较少，并且与副作用相关的停药率较低。
