Comparative study of trigger point injection versus stellate ganglion block in chronic shoulder-facial myofascial pain syndrome

After the study was approved by the ethical committee members, the patients were

informed about the study procedure and written informed consent was

obtained.Patients suspected to have craniofascial myofascial pain of all degrees of

severity were included. Patients diagnosed by clinical and imaging modalities in pain

OPD of institute of medical sciences -banaras hindu university.The patient’s vital

signs should be monitored before and immediately following the procedure.

A peripheral venous catheter should be placed in all patients. It is important to obtain

a detailed medical history before the procedure to rule out any contraindications and

evaluate the risk/benefits ratio.

1.USG GUIDED TRIGGER POINT INJECTION

After standard aseptic precautions high frequency linear usg probe would be placed

in the logitudinal and transverse plane to look for any changes in the muscle

underlying the spot marked on the skin. After anaesthetizing the skin with 1%

lidocaine, 22g 50mm stimuplex needle would be inserted in to the triggerpoint.

Trigger points are hypoechoic in nature.if the needling of suspected visible area

reproduced the pain normally experienced by the patient it is called needle sign.

Before injecting drug aspiration would be done to ensure that needle is not in the

vascular structure. Then 2-3 ml of bupivacaine 0.25% with dexamethazone 0.1mg/kg

would be injected into the trigger point.

2.USG GUIDED STELLATE GANGLION BLOCK

The patient would be supine with the neck slightly extended and the head slightly

rotated contralaterally to the approached side. After standared aseptic precaution

transducer would be placed perpendicular to the tracheal axis at the cricoid cartilage

slinding inferiorly until the superior aspect of the thyroid gland is visualized and

relocated laterally to the anterior aspect of the Chassaignac’s tubercle on the C6

transverse process. Color Doppler would be used to detect the position of the vessels.

With an in-plane approach, the needle would be placed adjacent to trachea , The tip of

the neede would be in prevertebral fascia of the Longus colli muscle . Proper

positioning of needle would be confirmed by hydrodissection,5ml of a local

anesthetic 0.25 % bupivacaine+ dexamethazone would be injected along the

paravertebral fascia to the stellate ganglion.The block would also be clinically

confirmed by ipsilateral Horner’s syndrome (ptosis, miosis, and anhydrosis), flushing

of the face, and increased temperature of the arm.