Stellate Ganglion Block in Control of Arrhythmia in Laparoscopic Cholecystectomy
Condition: Arrythmia; Pain, Acute
MeSH terms: Arrhythmias, Cardiac; Acute Pain
Study type: Interventional

Summary: 
      During Laparoscopic cholecystectomy, carbon dioxide (CO2) pneumoperitoneal laparoscopic
      surgery, CO2-pneumoperitoneum activates the sympathoadrenomedullary system to increase the
      release of catecholamines such as epinephrine (E) norepinephrine (NE) and dopamine (DA).
      During stress, E and NE are secreted by the adrenal medulla into blood circulation to promote
      glycogenolysis to increase blood glucose, speed up lipolysis and accelerate heartbeats.
      Stellate g anglion block (SGB) reters to the blockade of sympathetic nerves including the
      large area covered by middle cervical, vertebral arterial. stellate ganglions and ther pre-
      and post- ganglions. SGB affects both peripheral and central nervous systems. In the
      peripheral system. the sympathetic pre- and post-ganglionic fibers in the innervated areas of
      stellate ganglion are affected. Therefore, the control of vascular dilatation and
      constriction, muscular movement, bronchial smooth muscle relaxation and contraction, and pain
      conduction, by sympathetic nerves is inhibited. In the central nervous system, the
      hypothalamus is mainly involved in the regulation of systemic autonomic nervous, immune and
      endocrine systems, and to maintain homeostasis.

      CO2-pneumoperitoneum causes severe stress-related homeostatic disorders including arrhythmia
      and blood pressure changes. This study will examine the effects of stellate ganglion block
      (SGB) on hemodynamics and stress response in patients undergoing CO-pneumoperitoneal surgery.
    

Detailed description: 
      Laparoscopic surgery is being increasingly recognized for its advantages of minimal
      invasiveness. mild postoperative pain, short length of hospitalization and rapid recovery and
      is widely used in general surgery, obstetrics. gynecology and urology. Laparoscopic
      cholecystectomy (LC) has become the gold standard for surgically treating benign diseases of
      the gallbladder.

      During carbon dioxide (CO2) pneumoperitoneal laparoscopic surgery, CO2-pneumoperitoneum
      activates the sympathoadrenomedullary system to increase the release of catecholamines such
      as epinephrine (E) norepinephrine (NE) and dopamine (DA). During stress, E and NE are
      secreted by the adrenal medulla into blood circulation to promote glycogenolysis to increase
      blood glucose, speed up lipolysis and accelerate heartbeats. Stellate g anglion block (SGB)
      reters to the blockade of sympathetic nerves including the large area covered by middle
      cervical, vertebral arterial. stellate ganglions and ther pre- and post- ganglions. SGB
      affects both peripheral and central nervous systems. In the peripheral system. the
      sympathetic pre- and post-ganglionic fibers in the innervated areas of stellate ganglion are
      affected. Therefore, the control of vascular dilatation and constriction, muscular movement,
      bronchial smooth muscle relaxation and contraction, and pain conduction, by sympathetic
      nerves is inhibited. In the central nervous system, the hypothalamus is mainly involved in
      the regulation of systemic autonomic nervous, immune and endocrine systems, and to maintain
      homeostasis.

      CO2-pneumoperitoneum causes severe stress-related homeostatic disorders including arrhythmia
      and blood pressure changes. This study will examine the effects of stellate ganglion block
      (SGB) on hemodynamics and stress response in patients undergoing CO-pneumoperitoneal surgery.
    

Intervention name(s): right stellate ganglion block
Intervention type(s): Procedure
Intervention description(s): The skin should be anaesthetised with lidocaine 2%. Using a lateral approach and in-plane imaging, a blunt regional anaesthesia needle should be advanced deep to the carotid sheath towards the longus colli muscle. Following careful aspiration, inject 10 ml lidocaine 2% that will result in expansion of the fascia of the longus colli. Confirmation of the SGB success can be detected by warming of left upper limb and left Horner's syndrome.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Arrythmia; Acute pain