#36476 Cervical sympathetic chain/‘stellate ganglion’ block under ultrasound guidance to treat 15 year old olfactory dysfunction/anosmia

Abstract

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Background and Aims

Olfactory dysfunction/anosmia is a very difficult condition to treat and can be debilitating and dangerous for patients. Conventional management produces very poor outcome and cervical sympathetic chain block/’Stellate ganglion block’ (SGB) has shown dramatic effects for some patients. This is a case report of 50 year old male with history of anosmia for 15 years due to diabetes and sinus diseases treated successfully with ultrasound guided cervical sympathetic block.

Methods

He had right cervical sympathetic chain block at the level of C6 vertebra using ultrasound guidance (HF linear probe, 50 mm echogenic needle). 5 ml 1% lignocaine was given and left sided block done after 5 days using 0.5% Levo-bupivacaine under strict strict asepsis. Both times he developed Horner’s syndrome which is a sign of cervical sympathetic block.

Results

He started to get few range of smells after nearly 24 hours post procedure. Second procedure improved the response and the range of smell increased. It is still continuing after 2 months and he is doing smell retraining to improve it further.

Conclusions

Olfactory bulb is one part of brain with the ability to regenerate. Sympathetic block is shown to increase the blood flow to olfactory bulb and nerves area promoting regeneration which is the postulated mechanism of return of smell. Cervical sympathetic block/‘SGB’ block is a relatively simple and safe procedure to do especially under ultrasound guidance which can be used for not only treating various pain conditions, but for many other medical conditions including olfactory dysfunction.