Effect of the relative position of electrode and stellate ganglion during thermal radiofrequency ablation: a simulation study

Purpose Stellate ganglion (SG) block by thermal radiofrequency ablation (RFA) is frequently conducted as a therapeutic intervention for sympathetic-maintained and neuropathic pain syndromes. RFA's partial lack of effectiveness could be partly due to the ablation zone (AZ) not completely covering the SG section and therefore preventing the 'cutting' of the afferent pathways. Our objective was to build a theoretical model to conduct computer simulations to assess the effect of the electrode position relative to the SG. Methods A three-dimensional model was built including the SG and adjacent tissues (vertebrae C7-T1-T2, trachea, carotid artery and vertebral artery). RFA (90-s, 80 degrees C) was simulated considering a 22 G-5 mm electrode. The AZ was computed using the 50 degrees C isotherm. Results An electrode displacement of 2 mm in any direction from the optimal position (centered on the SG) meant that the AZ did not fully cover the SG section. Likewise, SG size considerably affected the RFA effectiveness since the AZ fully covered the section of small but not large SGs. Conclusions The findings suggest that the currently used SG RFA settings (i.e., 22 G-5 mm electrode, 90-s, 80 degrees C) may not be appropriate due to their inability to achieve an AZ that fully covers the SG cross section under certain circumstances, such as a large SG and non-optimal positioning of the RF electrode with respect to the SG center.

Automated summary

The study suggests that the effectiveness of SG RFA is influenced by the electrode positioning and the size of the ganglion, as the ablation zone may not fully cover the ganglion. This raises concerns about the appropriateness of the current RFA settings for SG.