{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T22:24:27Z","timestamp":1793312667029,"version":"4.5.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Stellate ganglion block (SGB) is a type of sympathetic block used to relieve pain in the face and upper extremities. However, its effectiveness can be limited by the presence of Kuntz fibers that bypass the stellate ganglion. Thoracic paravertebral block (TPVB) offers an alternative in such cases. We hypothesized that ultrasound (US)-guided TPVB would provide a higher success rate of upper extremity sympathetic blockade than US-guided SGB. Therefore, this prospective randomized study aimed to compare the technical success rates between US-guided TPVB and US-guided SGB and assess clinical outcomes in alleviating upper extremity pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      Patients aged 19 to 85 years diagnosed with chronic upper extremity pain (complex regional pain syndrome and neuropathic pain) were randomly assigned to either the US-guided TPVB group, where they received a 10 mL injection of 1% mepivacaine in the T2 paravertebral space, or the US-guided SGB group, where they received a 5 mL injection of 1% mepivacaine at the C6 level. The primary outcome was the success rate (%) of sympathetic blockade, which was predefined as the difference in temperature change between affected and unaffected hands 20 minutes after the procedure (\n                      <jats:italic toggle=\"yes\">\u0394<\/jats:italic>\n                      T difference) of \u2265 1.5\u00b0C. Secondary outcomes included comparisons of the\n                      <jats:italic toggle=\"yes\">\u0394<\/jats:italic>\n                      T difference (\u00b0C), differences in peak systolic velocities (cm\/s) of the ipsilateral brachial artery at 20 minutes, and pain intensity at baseline and 20 minutes, 1 week, and 4 weeks after the procedure using an 11-point numerical rating scale (NRS) pain score.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The TPVB group (N = 22\/35, 62.9%) showed a higher success rate than the SGB group (N = 13\/34, 38.2%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .041) in achieving the primary outcome of sympathetic blockade at 20 minutes. The difference in success rates between the 2 groups was 24.6 % (95% confidence interval [CI], \u22129.0% to 58.2%). The\n                      <jats:italic toggle=\"yes\">\u0394<\/jats:italic>\n                      T difference was significantly higher in TPVB than in SGB (2.0\u00b0C \u00b11.5 and 1.1\u00b0C \u00b11.3, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .008). The peak systolic velocities at 20 minutes increased in TPVB (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .005), which was not observed in SGB (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .325). Pain intensity decreased in both groups 20 minutes after injection (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001 in each group), and the TPVB group showed a lower 11-point NRS pain score compared to the SGB group (4.3 \u00b1 2.2 and 5.4 \u00b1 2.4, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .038). Pain intensity scores increased to preintervention levels in both groups at 1 week and 4 weeks after the interventions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>US-guided TPVB had a higher success rate of upper extremity sympathetic blockade than US-guided SGB, with more pronounced immediate postprocedural pain relief.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1213\/ane.0000000000007014","type":"journal-article","created":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T13:06:48Z","timestamp":1721912808000},"page":"665-674","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Multicenter Prospective Randomized Comparison of Ultrasound-Guided Stellate Ganglion Versus Thoracic Paravertebral Block for Sympathetic Blockade in Chronic Upper Extremity Pain"],"prefix":"10.1213","volume":"140","author":[{"given":"Jeongsoo","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon","family":"Cha","sequence":"additional","affiliation":[{"name":"University of South Florida, Morsani College of Medicine, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheung Nyoung","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Heo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongjae","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jee Youn","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,7,25]]},"reference":[{"key":"R1-20250224","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/AAP.0000000000000591","article-title":"Review of sympathetic blocks: anatomy, sonoanatomy, evidence, and techniques.","volume":"42","author":"Baig","year":"2017","journal-title":"Reg Anesth Pain Med"},{"key":"R2-20250224","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/AAP.0b013e3181b494de","article-title":"Development and validation of a new technique for ultrasound-guided stellate ganglion block.","volume":"34","author":"Gofeld","year":"2009","journal-title":"Reg Anesth Pain Med"},{"key":"R3-20250224","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1001\/archsurg.1927.01130240044003","article-title":"Distribution of the sympathetic rami to the brachial plexus: its relation to sympathectomy affecting the upper extremity.","volume":"15","author":"Kuntz","year":"1927","journal-title":"Arch Surg"},{"key":"R4-20250224","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1067\/mtc.2002.119340","article-title":"Anatomic variations of the T2 nerve root (including the nerve of Kuntz) and their implications for sympathectomy.","volume":"123","author":"Chung","year":"2002","journal-title":"J Thorac Cardiovasc Surg"},{"key":"R5-20250224","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1213\/ANE.0b013e3182274803","article-title":"Early thoracic sympathetic block improves the treatment effect for upper extremity neuropathic pain.","volume":"113","author":"Yoo","year":"2011","journal-title":"Anesth Analg"},{"key":"R6-20250224","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1177\/028418518702800503","article-title":"Percutaneous phenol block of the upper thoracic sympathetic chain with computed tomography guidance: a new technique.","volume":"28","author":"Dondelinger","year":"1987","journal-title":"Acta Radiol"},{"key":"R7-20250224","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1053\/j.trap.2007.05.007","article-title":"Complications of sympathetic blocks for extremity pain.","volume":"11","author":"Stanton-Hicks","year":"2007","journal-title":"Tech Regional Anesth Pain Manag"},{"key":"R8-20250224","article-title":"Thoracic sympathetic ganglion blocks: real-world outcomes in 207 chronic pain patients.","author":"Kim","journal-title":"Reg Anesth Pain Med"},{"key":"R9-20250224","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1097\/00000542-200109000-00033","article-title":"Thoracic paravertebral block.","volume":"95","author":"Karmakar","year":"2001","journal-title":"Anesthesiology"},{"key":"R10-20250224","doi-asserted-by":"crossref","first-page":"3395","DOI":"10.2147\/JPR.S285998","article-title":"Ultrasound-guided thoracic paravertebral block as a sympathetic blockade for upper extremity neuropathic pain: a prospective pilot study.","volume":"13","author":"Kim","year":"2020","journal-title":"J Pain Res"},{"key":"R11-20250224","doi-asserted-by":"crossref","first-page":"E417","DOI":"10.36076\/ppj\/2019.22.E417","article-title":"A prospective, randomized cross-over trial of T2 paravertebral block as a sympathetic block in complex regional pain syndrome.","volume":"22","author":"Kim","year":"2019","journal-title":"Pain Physician"},{"key":"R12-20250224","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1213\/ANE.0b013e3181dd58b0","article-title":"Ultrasound-guided thoracic paravertebral blockade: a cadaveric study.","volume":"110","author":"Cowie","year":"2010","journal-title":"Anesth Analg"},{"key":"R13-20250224","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/rapm-2019-100896","article-title":"Thoracic-paravertebral blocks: comparative anatomical study with different injection techniques and volumes.","volume":"45","author":"Seidel","year":"2020","journal-title":"Reg Anesth Pain Med"},{"key":"R14-20250224","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1053\/j.trap.2015.01.005","article-title":"Radiofrequency techniques: complications and troubleshooting.","volume":"18","author":"Roca","year":"2014","journal-title":"Tech Regional Anesth Pain Manag"},{"key":"R15-20250224","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1213\/ANE.0000000000001117","article-title":"Ultrasound-guided thoracic paravertebral blockade: a retrospective study of the incidence of complications.","volume":"122","author":"Pace","year":"2016","journal-title":"Anesth Analg"},{"key":"R16-20250224","doi-asserted-by":"crossref","first-page":"100","DOI":"10.4103\/0976-500X.72352","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials.","volume":"1","author":"Schulz","year":"2010","journal-title":"J Pharmacol Pharmacother"},{"key":"R17-20250224","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1111\/pme.12033","article-title":"Complex regional pain syndrome: practical diagnostic and treatment guidelines.","volume":"14","author":"Harden","year":"2013","journal-title":"Pain Med"},{"key":"R18-20250224","doi-asserted-by":"crossref","first-page":"ofz032","DOI":"10.1093\/ofid\/ofz032","article-title":"Normal body temperature: a systematic review.","volume":"6","author":"Geneva","year":"2019","journal-title":"Open Forum Inf Dis"},{"key":"R19-20250224","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1097\/ALN.0000000000000747","article-title":"Different approaches to ultrasound-guided thoracic paravertebral block: an illustrated review.","volume":"123","author":"Krediet","year":"2015","journal-title":"Anesthesiology"},{"key":"R20-20250224","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1097\/ALN.0b013e318289465f","article-title":"Magnetic resonance imaging analysis of the spread of local anesthetic solution after ultrasound-guided lateral thoracic paravertebral blockadea volunteer study.","volume":"118","author":"Marhofer","year":"2013","journal-title":"Anesthesiology"},{"key":"R21-20250224","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11916-014-0424-5","article-title":"Ultrasound-guided stellate ganglion block: safety and efficacy.","volume":"18","author":"Narouze","year":"2014","journal-title":"Curr Pain Headache Rep"},{"key":"R22-20250224","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.3390\/jcm8091314","article-title":"A randomized comparison between 4, 6 and 8 mL of local anesthetic for ultrasound-guided stellate ganglion block.","volume":"8","author":"Yoo","year":"2019","journal-title":"J Clin Med"},{"key":"R23-20250224","first-page":"266","article-title":"The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand.","volume":"23","author":"Stevens","year":"1998","journal-title":"Reg Anesth Pain Med"},{"key":"R24-20250224","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1093\/pm\/pnac035","article-title":"Correlation between temperature rise after sympathetic block and pain relief in patients with complex regional pain syndrome.","volume":"23","author":"Samen","year":"2022","journal-title":"Pain Med"},{"key":"R25-20250224","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1097\/ALN.0000000000004084","article-title":"Botulinum toxin type A for lumbar sympathetic ganglion block in complex regional pain syndrome: a randomized trial.","volume":"136","author":"Yoo","year":"2022","journal-title":"Anesthesiology"},{"key":"R26-20250224","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1111\/j.1365-2702.2005.01121.x","article-title":"Pain: a review of three commonly used pain rating scales.","volume":"14","author":"Williamson","year":"2005","journal-title":"J Clin Nurs"},{"key":"R27-20250224","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/S0363-5023(10)80065-6","article-title":"The measurement of cold sensitivity of the hand.","volume":"16","author":"McCabe","year":"1991","journal-title":"J Hand Surg"},{"key":"R28-20250224","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40557-019-0284-x","article-title":"Application of cold intolerance symptom severity questionnaire among vibration-exposed workers as a screening tool for the early detection of hand-arm vibration syndrome: a cross-sectional study.","volume":"31","author":"Kim","year":"2019","journal-title":"Ann Occup Environ Med"},{"key":"R29-20250224","doi-asserted-by":"crossref","first-page":"104739","DOI":"10.1016\/j.ijmedinf.2022.104739","article-title":"Opioid2MME: standardizing opioid prescriptions to morphine milligram equivalents from electronic health records.","volume":"162","author":"Lossio-Ventura","year":"2022","journal-title":"Int J Med Inform"},{"key":"R30-20250224","doi-asserted-by":"crossref","first-page":"18","DOI":"10.3344\/kjp.2017.30.1.18","article-title":"Guidelines for prescribing opioids for chronic non-cancer pain in Korea.","volume":"30","author":"Kim","year":"2017","journal-title":"Korean J Pain"},{"key":"R31-20250224","doi-asserted-by":"crossref","first-page":"378","DOI":"10.3344\/kjp.2020.33.4.378","article-title":"The analgesic efficacy of a single injection of ultrasound-guided retrolaminar paravertebral block for breast surgery: a prospective, randomized, double-blinded study.","volume":"33","author":"Hwang","year":"2020","journal-title":"Korean J Pain"},{"key":"R32-20250224","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1093\/bja\/aei250","article-title":"Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery.","volume":"95","author":"Vogt","year":"2005","journal-title":"Br J Anaesth"},{"key":"R33-20250224","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1046\/j.1469-7580.2001.19960675.x","article-title":"Thoracic origin of a sympathetic supply to the upper limb: the \u201cnerve of Kuntz\u201d revisited.","volume":"199","author":"Ramsaroop","year":"2001","journal-title":"J Anat"},{"key":"R34-20250224","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1016\/j.pain.2014.08.015","article-title":"Thoracic sympathetic block for the treatment of complex regional pain syndrome type I: a double-blind randomized controlled study.","volume":"155","author":"Rocha Rde","year":"2014","journal-title":"Pain"},{"key":"R35-20250224","doi-asserted-by":"crossref","first-page":"e783","DOI":"10.1016\/j.wneu.2017.10.088","article-title":"Does temperature increase by sympathetic neurolysis improve pain in complex regional pain syndrome? A retrospective cohort study.","volume":"109","author":"Dev","year":"2018","journal-title":"World Neurosurg"},{"key":"R36-20250224","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1097\/ALN.0000000000002899","article-title":"Outcomes of sympathetic blocks in the management of complex regional pain syndrome: a retrospective cohort study.","volume":"131","author":"Cheng","year":"2019","journal-title":"Anesthesiology"},{"key":"R37-20250224","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1213\/00000539-199104000-00022","article-title":"Plasma concentration of bupivacaine after stellate ganglion blockade.","volume":"72","author":"Wulf","year":"1991","journal-title":"Anesth Analg"},{"key":"R38-20250224","doi-asserted-by":"crossref","first-page":"199","DOI":"10.12701\/yujm.2018.35.2.199","article-title":"Comparison of ultrasound-guided stellate ganglion block at 6th and 7th cervical vertebrae using the lateral paracarotid out-of-plane approach for sympathetic blockade in the upper extremity.","volume":"35","author":"Baek","year":"2018","journal-title":"Yeungnam Univ J Med"}],"container-title":["Anesthesia &amp; Analgesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1213\/ANE.0000000000007014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:30:11Z","timestamp":1786113011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1213\/ANE.0000000000007014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,25]]},"references-count":38,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1213\/ane.0000000000007014","relation":{},"ISSN":["0003-2999","1526-7598"],"issn-type":[{"value":"0003-2999","type":"print"},{"value":"1526-7598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,25]]}}}