星状神经节阻滞常用局麻药的应用进展：机制、临床效果与安全性综述
Advances in the Application of Local Anesthetics for Stellate Ganglion Block: A Comprehensive Review of Mechanisms, Clinical Efficacy, and Safety Profiles
摘要: 星状神经节阻滞(Stellate Ganglion Block, SGB)作为一种针对交感神经的局部阻滞技术，近年来在疼痛管理、自主神经调节及多种复杂疾病的辅助治疗中显示出广泛的应用前景。随着对其机制的深入研究，局麻药的选择及其药理特性逐渐被重视，这直接影响SGB的疗效、安全性及持续时间。现有研究表明，不同局麻药在药效学、药代动力学及临床应用上存在显著差异。本文综述了近年来星状神经节阻滞中常用局麻药的应用进展，重点分析它们在临床中的实际效果及潜在风险，结合最新的临床研究和案例报道，探讨局麻药对SGB疗效的影响机制及未来发展趋势，旨在为临床实践提供科学依据，促进SGB技术的规范化和个体化应用。
Abstract: Stellate Ganglion Block (SGB), as a local blocking technique for sympathetic nerve, has shown a wide application prospect in pain management, autonomic nerve regulation and adjuvant treatment of various complex diseases in recent years. With the in-depth study of its mechanism, the choice of local anesthetics and their pharmacological characteristics have been gradually paid attention to, which directly affects the efficacy, safety and duration of SGB. The existing research shows that there are significant differences in pharmacodynamics, pharmacokinetics and clinical application of different local anesthetics. In this paper, the application progress of local anesthetics commonly used in stellate ganglion block in recent years is reviewed, and their actual clinical effects and potential risks are analyzed emphatically. Combined with the latest clinical research and case reports, the influence mechanism and future development trend of local anesthetics on the curative effect of SGB are discussed, aiming at providing scientific basis for clinical practice and promoting the standardized and individualized application of SGB technology.
文章引用：杨利彤, 范智东. 星状神经节阻滞常用局麻药的应用进展：机制、临床效果与安全性综述[J]. 临床医学进展, 2025, 15(9): 1747-1756. https://doi.org/10.12677/acm.2025.1592679

参考文献

[1] Giuliana, C., Filomia, S., Ricci, M., Pinnacchio, G., D’Aiello, A., Saponara, G., et al. (2025) Treating the Broken Heart: Role of Stellate Ganglion Blockade in Takotsubo Syndrome. Journal of Cardiovascular Pharmacology, 86, 234-238. [Google Scholar] [CrossRef] [PubMed]
[2] Blakey, S.M., Rae Olmsted, K.L., Hirsch, S., Asman, K., Wallace, D., Olmsted, M.G., et al. (2024) Differential Posttraumatic Stress Disorder Symptom Cluster Response to Stellate Ganglion Block: Secondary Analysis of a Randomized Controlled Trial. Translational Psychiatry, 14, Article No. 223. [Google Scholar] [CrossRef] [PubMed]
[3] Fang, Z.H., Ni, Y., Xie, H., Zhang, H.L. and Yang, J.X. (2025) Pupillary Ultrasonography vs Horner’s Syndrome to Evaluate Efficacy of Stellate Ganglion Block in Patients. IBRO Neuroscience Reports, 19, 264-271. [Google Scholar] [CrossRef] [PubMed]
[4] Samrid, R., King, M., Pujol, J., Reina, M.A., Iwanaga, J. and Tubbs, R.S. (2024) Anatomical and Histological Classification of the Stellate Ganglion: Implications for Clinical Nerve Blocks. Surgical and Radiologic Anatomy, 47, Article No. 26. [Google Scholar] [CrossRef] [PubMed]
[5] Reynolds, C.A. and Minic, Z. (2023) Chronic Pain-Associated Cardiovascular Disease: The Role of Sympathetic Nerve Activity. International Journal of Molecular Sciences, 24, Article 5378. [Google Scholar] [CrossRef] [PubMed]
[6] Li, Y. (2022) Stellate Ganglia and Cardiac Sympathetic Overactivation in Heart Failure. International Journal of Molecular Sciences, 23, Article 13311. [Google Scholar] [CrossRef] [PubMed]
[7] Quarti-Trevano, F., Seravalle, G. and Grassi, G. (2021) Clinical Relevance of the Sympathetic-Vascular Interactions in Health and Disease. Biomedicines, 9, Article 1007. [Google Scholar] [CrossRef] [PubMed]
[8] Bescond, J., Faivre, J.-F., Jean, A., Bois, P. and Chatelier, A. (2025) Ion Channel Expression in Intrinsic Cardiac Neurons: New Players in Cardiac Channelopathies? Biochimica et Biophysica Acta—Molecular Cell Research, 1872, Article 119983. [Google Scholar] [CrossRef] [PubMed]
[9] Carli, G., Kanel, P., Michalakis, F., Roytman, S., Bohnen, J.L.B., Wigstrom, T.P., et al. (2024) Cardiac Sympathetic Denervation and Anxiety in Parkinson Disease. Parkinsonism & Related Disorders, 124, Article 106997. [Google Scholar] [CrossRef] [PubMed]
[10] Ishii, M., Ishiyama, G., Ishiyama, A., Kato, Y., Mochizuki, F. and Ito, Y. (2022) Relationship between the Onset of Ménière's Disease and Sympathetic Hyperactivity. Frontiers in Neurology, 13, Article 804777. [Google Scholar] [CrossRef] [PubMed]
[11] Hrabalova, P., Bohuslavova, R., Matejkova, K., Papousek, F., Sedmera, D., Abaffy, P., et al. (2023) Dysregulation of Hypoxia-Inducible Factor 1α in the Sympathetic Nervous System Accelerates Diabetic Cardiomyopathy. Cardiovascular Diabetology, 22, Article No. 88. [Google Scholar] [CrossRef] [PubMed]
[12] Wang, Y., Liu, S., Liu, Q. and Lv, Y. (2022) The Interaction of Central Nervous System and Acute Kidney Injury: Pathophysiology and Clinical Perspectives. Frontiers in Physiology, 13, Article 826686. [Google Scholar] [CrossRef] [PubMed]
[13] Li, T.T., Wan, Q., Zhang, X., et al. (2022) Stellate Ganglion Block Reduces Inflammation and Improves Neurological Function in Diabetic Rats during Ischemic Stroke. Neural Regeneration Research, 17, 1991-1997. [Google Scholar] [CrossRef] [PubMed]
[14] Fan, Z., Zheng, X., Li, D., Chen, H. and Li, L. (2022) Comparison of Lidocaine and Ropivacaine Stellate Ganglion Blockade in Treating Upper Limb Postherpetic Neuralgia. Medicine, 101, e29394. [Google Scholar] [CrossRef] [PubMed]
[15] Morteza, H., Azadeh, B., Behnaz, A., Mehrdad, V., Mostafa, N., Hamed, S., et al. (2025) Enhancing Postoperative Pain Management: Assessing the Influence of Ultrasound-Guided Stellate Ganglion Block on Arteriovenous Fistula Surgery. Hemodialysis International, 29, 303-309. [Google Scholar] [CrossRef] [PubMed]
[16] Ouyang, R., Li, X., Wang, R., Zhou, Q., Sun, Y. and Lei, E. (2020) Effect of Ultrasound-Guided Right Stellate Ganglion Block on Perioperative Atrial Fibrillation in Patients Undergoing Lung Lobectomy: A Randomized Controlled Trial. Brazilian Journal of Anesthesiology (English Edition), 70, 256-261. [Google Scholar] [CrossRef] [PubMed]
[17] Zhang, J.X., Gao, P. and Liu, K. (2025) Ultrasound-Guided Stellate Ganglion Block with Ropivacaine for Postpartum Depression. American Journal of Translational Research, 17, 2258-2265. [Google Scholar] [CrossRef] [PubMed]
[18] Liu, Y., Zhang, L., Sun, Y., et al. (2023) Efficacy and Safety of Stellate Ganglion Block with Different Volumes of Ropivacaine to Improve Sleep Quality in Patients with Insomnia: A Comparative Study. European Review for Medical and Pharmacological Sciences, 27, 10233-10239.
[19] Sheikh, H. and Baig, T. (2023) Dexmedetomidine as an Adjunct in a Fluoroscopically Guided Stellate Ganglion Block for Complex Regional Pain Syndrome. Cureus, 15, e40504. [Google Scholar] [CrossRef] [PubMed]
[20] Calderipe, C.B., Kirschnick, L.B., Esteves-Pereira, T.C., dos Santos, E.S., Vasconcelos, A.C.U., Lopes, M.A., et al. (2024) Local Anesthesia Nerve Block for Managing Burning Mouth Syndrome: A Scoping Review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 138, 619-625. [Google Scholar] [CrossRef] [PubMed]
[21] Shrestha, B.R., Lama, S. and Shrestha, U. (2021) Ultrasound Guided Stellate Ganglion Block with Dexmedetomidine as an Adjuvant in Complex Regional Pain Syndrome (CRPS). Kathmandu University Medical Journal, 19, 148-151. [Google Scholar] [CrossRef] 
[22] Kuroda, H., Katagiri, N., Kagawa, K., Imaizumi, U., Ishikawa, N., Shibukawa, Y., et al. (2023) Comparison of Lidocaine and Mepivacaine for Variation in Regional Tissue Oxygenation in Stellate Ganglion Block: A Randomized, Double-Blind, Crossover Trial. Cureus, 15, e47938. [Google Scholar] [CrossRef] [PubMed]
[23] Kim, J., Cha, J., Choi, S.N., Heo, G., Yoo, Y. and Moon, J.Y. (2025) Multicenter Prospective Randomized Comparison of Ultrasound-Guided Stellate Ganglion versus Thoracic Paravertebral Block for Sympathetic Blockade in Chronic Upper Extremity Pain. Anesthesia & Analgesia, 140, 665-674. [Google Scholar] [CrossRef] [PubMed]
[24] Fischer, L., Barop, H., Ludin, S.M. and Schaible, H. (2022) Regulation of Acute Reflectory Hyperinflammation in Viral and Other Diseases by Means of Stellate Ganglion Block. A Conceptual View with a Focus on Covid-19. Autonomic Neuroscience, 237, Article 102903. [Google Scholar] [CrossRef] [PubMed]
[25] Prasad, S., Jain, N., Umar, T.P., Radenkov, I., Ahmed, S.K., Sakagianni, V., et al. (2023) Sympathetic Nerve Blocks for Posttraumatic Stress Disorder: An Evidentiary Review for Future Clinical Trials. Frontiers in Psychiatry, 14, Article 1309986. [Google Scholar] [CrossRef] [PubMed]
[26] Fajardo Pérez, M., Yamak-Altinpulluk, E., Díez Tafur, R., Salazar-Zamorano, C.H., Espinosa Morales, K., Oliver-Fornies, P., Rocha-Romero, A., Aguilar Ureña, R., Juarez-Lemus, A., Galluccio, F. and Abd-Elsayed, A. (2024) Novel Ultrasound-Guided Supraclavicular Stellate Ganglion Block. Pain Practice, 24, 808-814.
[27] Wu, H., Huang, X., Xu, H., Yang, H., Liu, Z., Liu, F., et al. (2025) Bupivacaine Nanoparticles Inhibit Triple-Negative Breast Tumor Growth by Suppressing the Noradrenergic Nerves in Tumor Microenvironment. International Journal of Nanomedicine, 20, 6023-6041. [Google Scholar] [CrossRef] [PubMed]
[28] Lipov, E., Gluncic, V., Lukić, I.K. and Candido, K. (2020) How Does Stellate Ganglion Block Alleviate Immunologically-Linked Disorders? Medical Hypotheses, 144, Article 110000. [Google Scholar] [CrossRef] [PubMed]
[29] Plakhotnik, J., Zhang, L., Estrada, M., Coles, J.G., Lonnqvist, P. and Maynes, J.T. (2022) Local Anesthetic Cardiac Toxicity Is Mediated by Cardiomyocyte Calcium Dynamics. Anesthesiology, 137, 687-703. [Google Scholar] [CrossRef] [PubMed]
[30] Jiang, T., Ma, C., Wang, Z. and Miao, Y. (2024) A Review of Local Anesthetic-Induced Heart Toxicity Using Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes. Molecular and Cellular Probes, 76, Article 101965. [Google Scholar] [CrossRef] [PubMed]
[31] Joudeh, L., Sabouri, A.S., Cho, J., Vasquez, R., Kamdar, B. and Hao, D. (2025) Local Anesthetic Systemic Toxicity. A & A Practice, 19, e01893. [Google Scholar] [CrossRef] [PubMed]
[32] Denke, N.J. (2024) Local Anesthetic Systemic Toxicity (LAST): More Common than You Think. Journal of Emergency Nursing, 50, 336-341. [Google Scholar] [CrossRef] [PubMed]
[33] Zhang, K., Li, M., Yao, W. and Wan, L. (2023) Cytotoxicity of Local Anesthetics on Bone, Joint, and Muscle Tissues: A Narrative Review of the Current Literature. Journal of Pain Research, 16, 611-621. [Google Scholar] [CrossRef] [PubMed]
[34] Tan, Y.Z., Shi, R.J., Ke, B.W., Tang, Y.L. and Liang, X.H. (2023) Paresthesia in Dentistry: The Ignored Neurotoxicity of Local Anesthetics. Heliyon, 9, e18031. [Google Scholar] [CrossRef] [PubMed]
[35] Ji, Z.H., Zhou, Y., Wang, H., Li, S., Liang, G.Q. and Mao, J. (2020) Inhibition of DNA Repair Protein Ku70 in High‐glucose Environment Aggravates the Neurotoxicity Induced by Bupivacaine in SH‐SY5Y Cells. BioMed Research International, 2020, Article 1283214. [Google Scholar] [CrossRef] [PubMed]
[36] Dai, S.H., Li, Y.W., Hong, Q.X., Su, T. and Xu, S.Y. (2021) Exaggerated Activities of TRPM7 Underlie Bupivacaine‐induced Neurotoxicity in the SH‐SY5Y Cells Preconditioned with High Glucose. Journal of Biochemical and Molecular Toxicology, 35, e22826. [Google Scholar] [CrossRef] [PubMed]
[37] Asan, C.Y., Ağyüz, G., Canpolat, D.G., Demirbas, A.E., Asan, M., Yay, A., et al. (2022) Chondrotoxic Effects of Intra-Articular Injection of Local Anaesthetics in the Rabbit Temporomandibular Joint. International Journal of Oral and Maxillofacial Surgery, 51, 1337-1344. [Google Scholar] [CrossRef] [PubMed]
[38] Pirri, C., Sorbino, A., Manocchio, N., Pirri, N., Devito, A., Foti, C., et al. (2024) Chondrotoxicity of Intra-Articular Injection Treatment: A Scoping Review. International Journal of Molecular Sciences, 25, Article 7010. [Google Scholar] [CrossRef] [PubMed]
[39] Huang, C., Shu, S., Zhou, M., Sun, Z. and Li, S. (2024) Stellate Ganglion Block Therapy in Management of Ventricular Electrical Storm: A Case Report. Heliyon, 10, e37724. [Google Scholar] [CrossRef] [PubMed]
[40] Salvagno, M., Gouvea Bogossian, E., Halenarova, K., Ego, A. and Taccone, F.S. (2023) Cervical Ganglion Sympathectomy to Treat Cerebral Vasospasm in Subarachnoid Hemorrhage. Neurocritical Care, 39, 241-249. [Google Scholar] [CrossRef] [PubMed]
[41] Sterling, L., Fisher, K. and Woodbury, A. (2025) Stellate Ganglion Block for PTSD and Chronic Low Back Pain: A Case Report of Three Veterans. Journal of Clinical Medicine, 14, Article 3375. [Google Scholar] [CrossRef] [PubMed]
[42] Ma, H., Pan, Z., Lai, B., Zan, C. and Liu, H. (2023) Recent Research Advances in Nano-Based Drug Delivery Systems for Local Anesthetics. Drug Design, Development and Therapy, 17, 2639-2655. [Google Scholar] [CrossRef] [PubMed]
[43] Qi, R.Q., Liu, W., Wang, D.Y., Meng, F.Q., Wang, H.Y. and Qi, H.Y. (2021) Development of Local Anesthetic Drug Delivery System by Administration of Organo-Silica Nanoformulations under Ultrasound Stimuli: In Vitro and in Vivo Investigations. Drug Delivery, 28, 54-62. [Google Scholar] [CrossRef] [PubMed]
[44] Bebawy, G., Sokar, M.S. and Abdallah, O.Y. (2024) Buccal Lidocaine Mucoadhesive Patches for Pediatrics’ Teething Pain: Overcoming Possible Hazards of Oral Gels. Pharmaceutical Development and Technology, 29, 805-813. [Google Scholar] [CrossRef] [PubMed]
[45] Zhang, Y., Feng, S., Cheng, X., Lou, K., Liu, X., Zhuo, M., et al. (2023) The Potential Value of Exosomes as Adjuvants for Novel Biologic Local Anesthetics. Frontiers in Pharmacology, 14, Article 1112743. [Google Scholar] [CrossRef] [PubMed]

为你推荐