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Qureshi AI, Waqas MA, Jadhav V, et al. Long Acting Liposomal Bupivacaine for Percutaneous Sympathetic Stellate Ganglion Blockade: A Technical Note. J Vasc Interv Neurol. 2017;9(5):49-53
Qureshi, A. I., Waqas, M. A., Jadhav, V., Saleem, M. A., Campbell, J., & Wallery, S. S. (2017). Long Acting Liposomal Bupivacaine for Percutaneous Sympathetic Stellate Ganglion Blockade: A Technical Note. Journal of vascular and interventional neurology, 9(5), 49-53.
Qureshi, Adnan I, et al. "Long Acting Liposomal Bupivacaine for Percutaneous Sympathetic Stellate Ganglion Blockade: A Technical Note." Journal of vascular and interventional neurology vol. 9,5 (2017): 49-53.
Qureshi AI, Waqas MA, Jadhav V, Saleem MA, Campbell J, Wallery SS. Long Acting Liposomal Bupivacaine for Percutaneous Sympathetic Stellate Ganglion Blockade: A Technical Note. J Vasc Interv Neurol. 2017 Oct;9(5):49-53. PMID: 29163750; PMCID: PMC5683018.
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J Vasc Interv Neurol. 2017 Oct;9(5):49-53.

Long Acting Liposomal Bupivacaine for Percutaneous Sympathetic Stellate Ganglion Blockade: A Technical Note.

Journal of vascular and interventional neurology

Adnan I Qureshi, Muhammad A Waqas, Vikram Jadhav, Muhammad A Saleem, Jeff Campbell, Shawn S Wallery

Affiliations

  1. Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA.
  2. University of Illinois and Mercy health, Rockford, IL, USA.
  3. Mercyhealth, Janesville, WI, USA.

PMID: 29163750 PMCID: PMC5683018

Abstract

INTRODUCTION: We describe the use of long acting liposomal bupivacaine for percutaneous stellate ganglion blockade to treat severe headaches following internal carotid artery dissection.

METHODS: A 43-year old woman developed right-sided refractory headache after right internal carotid artery dissection. Patient underwent percutaneous stellate ganglion block using bupivacaine hydrochloride (0.25%-20 ml) in the past with short acting relief. Liposomal bupivacaine (EXPAREL) 13.3 mg/mL (1.3%) solution diluted with preservative-free normal saline: a total solution of 20 ml (52 mg of bupivacaine) was injected at the level of the lower portion of body of the sixth cervical vertebra, medial to the right internal carotid artery. The response to sympathetic block was assessed by a neurologist not involved in the procedure.

RESULTS: After the stellate ganglion block with bupivacaine hydrochloride, patient was headache free immediately after the block but with recurrence of pain on Day 3 with return to peak intensity by Day 4. After the stellate ganglion blockade with liposomal bupivacaine hydrochloride, patient reported recurrence of pain on Day 15 post injection with return to peak intensity by Day 17. The patient reported an episode of aura which consisted of visual scintillations on Day 2 which lasted for five days and resolved spontaneously.

CONCLUSION: Liposomal bupivacaine injection for stellate ganglion blockade can result in a more prolonged effect compared with bupivacaine hydrochloride.

Keywords: Sympathetic blockade; internal carotid artery dissection; liposomal bupivacaine; stellate ganglion blockade

Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflict of interest.

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