Skip to main content
Top
Published in: Pain and Therapy 3/2024

Open Access 25-04-2024 | Trigeminal Neuralgia | CASE SERIES

Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion: MRI-Verified Solution Spread

Authors: Stefan Neuwersch-Sommeregger, Markus Köstenberger, Andreas Sandner-Kiesling, Matthias Fürstner, Isabel Igerc, Brigitte Trummer, Jessica Wuntschek, Wolfgang Pipam, Haro Stettner, Rudolf Likar, Georg Feigl

Published in: Pain and Therapy | Issue 3/2024

Login to get access

Abstract

Introduction

Ganglionic local opioid analgesia (GLOA) at the superior cervical ganglion (SCG) is performed for pain control and is known to be an effective procedure. In this study, we evaluated the spread of the injectate in the area of the SCG. Our expectation was that there would be a correlation between the area and volume of the injectate spread and post-procedural outcome measures.

Methods

This was a retrospective blinded review of magnetic resonance imaging (MRI) scans. Assessors evaluated the anatomical area of fluid spread, the furthermost spread from midline, any hampered spread and contact of contrast fluid with other structures. The efficacy of GLOA and complications were estimated.

Results

The main solution spread reached from the C1 to C3 vertebrae. The furthest spread in the lateral and sagittal planes was 21.2 and 15.2 mm, respectively. The furthest craniocaudal spread was 63.5 mm. In 53.3% and 33% of interventions, the solution was found in the parapharyngeal space and in its “medial compartment,” respectively. A correlation was found between pain relief and both solution spread and volume of solution spread. No hampered spread was recorded. A negative correlation between pain reduction and number of GLOA was observed. Higher pre-procedural pain intensity was correlated with higher pain reduction. We estimated pain relief in 93% of procedures correctly. No correlation between post-procedural Numerical Rating Scale (NRS) scores and different needle approaches was found.

Conclusion

For the transoral blocking technique, a strict laterodorsal needle direction is recommended to prevent possible block failures. A total volume of 2 ml injected into the parapharyngeal space and its “medial compartment” is recommended. Higher volumes may lead to uncontrolled distribution patterns.

Trial registration

Clinicaltrials.gov identifier NCT05257655; date of registration 2022-02-25; patient enrollment date from 2023-01-09 to 2023-08-31.
Literature
1.
go back to reference Knolle E, Kress HG. Ganglionic local opioid analgesia. Clinical effect and local extent. Schmerz. 2006;20:265–6.CrossRefPubMed Knolle E, Kress HG. Ganglionic local opioid analgesia. Clinical effect and local extent. Schmerz. 2006;20:265–6.CrossRefPubMed
2.
go back to reference Siegenthaler A, Haug M, Eichenberger U, et al. Block of the superior cervical ganglion, description of a novel ultrasound-guided technique in human cadavers. Pain Med. 2013;14:646–9.CrossRefPubMed Siegenthaler A, Haug M, Eichenberger U, et al. Block of the superior cervical ganglion, description of a novel ultrasound-guided technique in human cadavers. Pain Med. 2013;14:646–9.CrossRefPubMed
3.
go back to reference Feigl G, Rosmarin W, Likar R. Block of the superior cervical ganglion of the Truncus sympathicus. Why it often is not possible! Schmerz. 2006;20:277–80, 282–4 (in German). Feigl G, Rosmarin W, Likar R. Block of the superior cervical ganglion of the Truncus sympathicus. Why it often is not possible! Schmerz. 2006;20:277–80, 282–4 (in German).
4.
5.
go back to reference Grodinsky M. The fascia and fascial spaces of the head and neck and adjacent regions. Am J Anat. 2005;63:367–408.CrossRef Grodinsky M. The fascia and fascial spaces of the head and neck and adjacent regions. Am J Anat. 2005;63:367–408.CrossRef
6.
go back to reference Feigl G. Fascia and spaces on the neck: myths and reality. Med Flum. 2015;51:430–9. Feigl G. Fascia and spaces on the neck: myths and reality. Med Flum. 2015;51:430–9.
7.
go back to reference Feigl G, Hammer GP, Litz R, et al. The intercarotid or alar fascia, other cervical fascias, and their adjacent spaces—a plea for clarification of cervical fascia and spaces terminology. J Anat. 2020;237:197–207.CrossRefPubMedPubMedCentral Feigl G, Hammer GP, Litz R, et al. The intercarotid or alar fascia, other cervical fascias, and their adjacent spaces—a plea for clarification of cervical fascia and spaces terminology. J Anat. 2020;237:197–207.CrossRefPubMedPubMedCentral
8.
go back to reference Elsner F, Radbruch L, Gaertner J, et al. Efficacy of opioid analgesia at the superior cervical ganglion in neuropathic head and facial pain. Schmerz. 2006;20:268–72, 274–6 (in German). Elsner F, Radbruch L, Gaertner J, et al. Efficacy of opioid analgesia at the superior cervical ganglion in neuropathic head and facial pain. Schmerz. 2006;20:268–72, 274–6 (in German).
9.
go back to reference Feigl G, Anderhuber F, Fasel JH, et al. Meaning of stylopharyngeal fascia in intraoral block techniques. Schmerz. 2007;21:28, 30-3 (in German). Feigl G, Anderhuber F, Fasel JH, et al. Meaning of stylopharyngeal fascia in intraoral block techniques. Schmerz. 2007;21:28, 30-3 (in German).
10.
go back to reference Hafferl (1969) Lehrbuch der topographischen anatomie. Springer, Berlin Heidelberg New York Hafferl (1969) Lehrbuch der topographischen anatomie. Springer, Berlin Heidelberg New York
11.
go back to reference Harris CL, Hamid B, Rosenquist RW, et al. Ganglionic local opioid application (GLOA) for treatment of chronic headache and facial pain. Reg Anesth Pain Med. 2006;31:460–2.CrossRefPubMed Harris CL, Hamid B, Rosenquist RW, et al. Ganglionic local opioid application (GLOA) for treatment of chronic headache and facial pain. Reg Anesth Pain Med. 2006;31:460–2.CrossRefPubMed
12.
go back to reference Spacek A, Bohm D, Kress HG. Ganglionic local opioid analgesia for refractory trigeminal neuralgia. Lancet. 1997;349:1521.CrossRefPubMed Spacek A, Bohm D, Kress HG. Ganglionic local opioid analgesia for refractory trigeminal neuralgia. Lancet. 1997;349:1521.CrossRefPubMed
13.
go back to reference Spacek A, Hanl G, Groiss O, et al. Acupuncture and ganglionic local opioid analgesia in trigeminal neuralgia. Wien Med Wochenschr. 1998;148:447–9.PubMed Spacek A, Hanl G, Groiss O, et al. Acupuncture and ganglionic local opioid analgesia in trigeminal neuralgia. Wien Med Wochenschr. 1998;148:447–9.PubMed
14.
go back to reference Chong MS, Bahra A, Zakrzewska JM. Guidelines for the management of trigeminal neuralgia. Cleve Clin J Med. 2023;90:355–62.CrossRefPubMed Chong MS, Bahra A, Zakrzewska JM. Guidelines for the management of trigeminal neuralgia. Cleve Clin J Med. 2023;90:355–62.CrossRefPubMed
15.
go back to reference Pejic S. Transoral block of the cervico-endocranial sympathetic system in otorhinolaryngology. Srp Arh Celok Lek. 1965;93:719–30 (in Russian). Pejic S. Transoral block of the cervico-endocranial sympathetic system in otorhinolaryngology. Srp Arh Celok Lek. 1965;93:719–30 (in Russian).
16.
go back to reference Yokota H, Mukai H, Hattori S, et al. MR imaging of the superior cervical ganglion and inferior ganglion of the vagus nerve: structures that can mimic pathologic retropharyngeal lymph nodes. Am J Neuroradiol. 2018;39:170–6.CrossRefPubMedPubMedCentral Yokota H, Mukai H, Hattori S, et al. MR imaging of the superior cervical ganglion and inferior ganglion of the vagus nerve: structures that can mimic pathologic retropharyngeal lymph nodes. Am J Neuroradiol. 2018;39:170–6.CrossRefPubMedPubMedCentral
18.
go back to reference Schmidt J, Lamprecht F, Wittmann WW. Satisfaction with inpatient management. Development of a questionnaire and initial validity studies. Psychother Psychosom Med Psychol. 1989;39:248–55.PubMed Schmidt J, Lamprecht F, Wittmann WW. Satisfaction with inpatient management. Development of a questionnaire and initial validity studies. Psychother Psychosom Med Psychol. 1989;39:248–55.PubMed
19.
go back to reference Fabbri M, Beracci A, Martoni M et al. (2021) Measuring subjective sleep quality: a review. Int J Environ Res Public Health. 18(3):1082. Fabbri M, Beracci A, Martoni M et al. (2021) Measuring subjective sleep quality: a review. Int J Environ Res Public Health. 18(3):1082.
Metadata
Title
Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion: MRI-Verified Solution Spread
Authors
Stefan Neuwersch-Sommeregger
Markus Köstenberger
Andreas Sandner-Kiesling
Matthias Fürstner
Isabel Igerc
Brigitte Trummer
Jessica Wuntschek
Wolfgang Pipam
Haro Stettner
Rudolf Likar
Georg Feigl
Publication date
25-04-2024
Publisher
Springer Healthcare
Published in
Pain and Therapy / Issue 3/2024
Print ISSN: 2193-8237
Electronic ISSN: 2193-651X
DOI
https://doi.org/10.1007/s40122-024-00596-4

Other articles of this Issue 3/2024

Pain and Therapy 3/2024 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Webinar | 06-02-2024 | 20:00 (CET)

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by: Viatris

Developed by: Springer Healthcare