Regional anesthesia for arrhythmias: a review of current literature.

Purpose of the review: The aim is to provide a comprehensive review of regional anesthesia techniques to control ventricular arrhythmias.

Recent findings: While promising, the use of stellate ganglion block (SGB) for arrhythmia control is still under investigation, and further clinical trials are warranted to fully understand its efficacy, long-term outcomes, suitable patient group, and safety profile. Nevertheless, it remains a potential adjunctive therapy in the management of ventricular arrhythmias in select patients. Continuous stellate ganglion block (C-SGB) offers an alternative to single-shot SGB and thoracic epidural anesthesia for effective management in the reduction of ventricular arrhythmias until definitive treatment; it is safe and may reduce the need to repeat the single-shot block.

Summary: SGB has been described in the literature as a successful adjunct therapy to reduce arrhythmia load. Blocking the stellate ganglion can provide transient sympathetic blockade for controlling refractory ventricular arrhythmias, otherwise uncontrolled with medication management. By regulating the sympathetic nervous system, the stellate ganglion affects the electrical conductance of the heart, and thus inhibition of the ganglion can modulate the autonomic balance with subsequent reduction in ventricular arrhythmias. These studies until 2017 were limited to case reports and case series; meta-analysis by Fudim et al. supports the use of left-sided SGB to manage ventricular arrhythmias. Recent clinical trials further strengthen the findings and favor the trend of catheter use for continuous SGB. Further studies are warranted to identify suitable patient groups and when to initiate SBG or C-SGB.