Ultrasound-guided low-volume continuous cervical sympathetic nerve block for treatment of an electrical storm

In addition to the treatment for complex regional pain syndrome (CRPS), the stellate ganglion block is a treatment option for refractory intermittent ventricular tachycardia (VT). Despite the use of imaging techniques, such as fluoroscopy and ultrasound, numerous side effects and complications have been reported. These are a result of the complex anatomical site and the volume of injected local anesthetics. This article reports on the catheter placement for continuous block of the cervical sympathetic trunk with high-resolution ultrasound imaging (HRUI) in a patient with intermittent VT. The tip of the cannula was placed on the anterior aspect of the longus colli muscle and 20 mg prilocaine 1% (2 ml) was injected. The VT stopped and a continuous infusion of 1 ml/h ropivacaine 0,2 % was started. Nevertheless, during the next hour the patient developed hoarseness and dysphagia, so that a block of the recurrent laryngeal nerve and the deep ansa cervicalis (C1-C3) was carried out. The infusion was paused and restarted later with 0.5 ml/h. The spread of the local anesthetic was controlled by ultrasound. Over the next 4 days the patient showed no VT or detectable side effects. After implantation of a defibrillator 1 day later the patient could then be discharged home on the following day. This case shows that the HRUI can be advantageously used in the catheter placement and also when adjusting the flow rate. In this way the risk of complications and side effects related to the puncture and local anesthetic volume can be reduced.