Effectiveness of Stellate Ganglion Block on Chest Pain Severity and ST-Segment Changes in Patients with Refractory Angina: An Interventional Study

Ebrahim Espahbodi; Mahsa Raji; Reza Rahmani; Saghar Samimi; Mehrzad Rahmanian; Ali Karbasforoshan; Mehdi Sanatkar

doi:10.18502/aacc.v12i1.20537

Ebrahim Espahbodi Pain Research Center, Neuroscience Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Mahsa Raji Department of Cardiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Reza Rahmani Department of Cardiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Saghar Samimi Department of Anesthesiology, Critical Care and Pain Management, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Mehrzad Rahmanian Department of Cardiac Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Ali Karbasforoshan Department of Cardiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
Mehdi Sanatkar Anesthesia, Critical Care and Pain Management Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v12i1.20537

Keywords: Refractory angina; Stellate ganglion block; Chest pain; ST-segment deviation; Coronary artery disease

Abstract

Background: Refractory angina remains a major therapeutic challenge when revascularization options are unavailable. Stellate ganglion block (SGB) may reduce sympathetic tone, improve coronary perfusion, and alleviate ischemic chest pain. This study evaluated the effects of SGB on the severity of chest pain and ST-segment deviation during exercise testing.

Methods: This before–and–after interventional study included patients with confirmed coronary artery disease and refractory angina. Baseline treadmill testing assessed angina index and ST-segment deviation. SGB was performed under ultrasound guidance using 0.25% bupivacaine and dexamethasone. Treadmill testing was repeated 24–48 hours after the block.

Results: Sixteen patients participated (56% male; mean age 60.7±9.7 years). The angina index significantly improved (1.90±0.34 to 0.50±0.32; P < 0.001). ST-segment deviation decreased modestly but significantly (1.0±0.4 to 0.9±0.3 mm; P=0.041). No major complications occurred.

Conclusion: SGB significantly reduced chest pain severity and improved ischemic ST-segment abnormalities in patients with refractory angina. It may serve as a safe and effective adjunct therapy.