Stellate ganglion block for sepsis-related organ dysfunction: mechanisms and clinical advances_West China Medical Journal

Authors：

WANG Linchuan ¹ , TANG Xuemei ² , XIANG Chunlin ² , WANG Yiping ² ,  WU Xiaoxiao ²

1. Department of Critical Care Medicine, Dazhou Dachuan District People’s Hospital, Dazhou, Sichuan 635000, P. R. China;
2. Center for Critical Care Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding author：

WU Xiaoxiao, Email: wuxiaoxiao@med.uestc.edu.cn

Keywords：

Stellate ganglion block; sepsis; acute lung injury; ventricular arrhythmia; limb ischemia; neuro-immune modulation

DOI：

10.7507/1002-0179.202503233

Video：

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Abstract Full text Figures/Tables Video References Cited by

Sepsis-associated organ dysfunction arises from uncontrolled inflammation and immune dysregulation, causing microcirculatory impairment and multi-organ failure. Stellate ganglion block (SGB) may confer organ protection by regulating the sympathetic nervous system and hypothalamic-pituitary-adrenal axis to suppress excessive inflammation and oxidative stress. Available evidence, mainly from experimental and small clinical studies, suggests potential benefits of SGB in sepsis-induced acute lung injury, ventricular arrhythmias, and limb ischemia, which require confirmation in multicenter randomized controlled trials. This review outlines the mechanisms and clinical advances of SGB in sepsis-related organ dysfunction, providing a theoretical basis for its application in critical care.

Citation： WANG Linchuan, TANG Xuemei, XIANG Chunlin, WANG Yiping, WU Xiaoxiao. Stellate ganglion block for sepsis-related organ dysfunction: mechanisms and clinical advances. West China Medical Journal, 2025, 40(8): 1333-1339. doi: 10.7507/1002-0179.202503233 Copy

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1. Yuan Y, Chen L. Clinical effect of perioperative stellate ganglion block on mechanical ventilation and respiratory function of elderly patients with septic shock. Medicine (Baltimore), 2024, 103(21): e38166.
2. 刘毅, 赵劲民, 农朋海, 等. 颈胸交感神经的解剖及临床意义. 中华手外科杂志, 2011, 27(5): 303-305.
3. Bataille B, Nucci B, Mora M, et al. Ultrasound-guided bilateral stellate ganglion blockade to treat digital ischemia in a patient with sepsis: a case report. Can J Anaesth, 2016, 63(1): 56-60.
4. Chen Y, Guo L, Lang H, et al. Effect of a stellate ganglion block on acute lung injury in septic rats. Inflammation, 2018, 41(5): 1601-1609.
5. Benarroch EE. Autonomic nervous system and neuroimmune interactions: new insights and clinical implications. Neurology, 2019, 92(8): 377-385.
6. Fischer L, Barop H, Ludin SM, et al. 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. Auton Neurosci, 2022, 237: 102903.
7. Liu LD, Duricka DL. Stellate ganglion block reduces symptoms of Long COVID: a case series. J Neuroimmunol, 2022, 362: 577784.
8. Elenkov IJ, Wilder RL, Chrousos GP, et al. The sympathetic nerve--an integrative interface between two supersystems: the brain and the immune system. Pharmacol Rev, 2000, 52(4): 595-638.
9. Madden KS, Sanders VM, Felten DL. Catecholamine influences and sympathetic neural modulation of immune responsiveness. Annu Rev Pharmacol Toxicol, 1995, 35: 417-448.
10. Anagnostou VK, Doussis-Anagnostopoulou I, Tiniakos DG, et al. Ontogeny of intrinsic innervation in the human thymus and spleen. J Histochem Cytochem, 2007, 55(8): 813-820.
11. Yokoyama M, Nakatsuka H, Itano Y, et al. Stellate ganglion block modifies the distribution of lymphocyte subsets and natural-killer cell activity. Anesthesiology, 2000, 92(1): 109-115.
12. Yang X, Shi Z, Li X, et al. Impacts of stellate ganglion block on plasma NF-κB and inflammatory factors of TBI patients. Int J Clin Exp Med, 2015, 8(9): 15630-15638.
13. Ağaç D, Estrada LD, Maples R, et al. The β₂-adrenergic receptor controls inflammation by driving rapid IL-10 secretion. Brain Behav Immun, 2018, 74: 176-185.
14. Chavan SS, Pavlov VA, Tracey KJ. Mechanisms and therapeutic relevance of neuro-immune communication. Immunity, 2017, 46(6): 927-942.
15. Szabadi E. Functional neuroanatomy of the central noradrenergic system. J Psychopharmacol, 2013, 27(8): 659-693.
16. Hicky A, Hanling S, Pevney E, et al. Stellate ganglion block for PTSD. Am J Psychiatry, 2012, 169(7): 760.
17. Udit S, Blake K, Chiu IM. Somatosensory and autonomic neuronal regulation of the immune response. Nat Rev Neurosci, 2022, 23(3): 157-171.
18. Wrona D. Neural-immune interactions: an integrative view of the bidirectional relationship between the brain and immune systems. J Neuroimmunol, 2006, 172(1/2): 38-58.
19. Lipov E, Gluncic V, Lukić IK, et al. How does stellate ganglion block alleviate immunologically-linked disorders?. Med Hypotheses, 2020, 144: 110000.
20. Jiang C, Cai L, Zhang J, et al. Stellate ganglion block in the treatment of SAPHO syndrome: a case report. Mod Rheumatol Case Rep, 2024, 8(2): 361-364.
21. Li Y, Zhang W, Wang H, et al. Case report: a new treatment for restless leg syndrome: three cases. Front Neurosci, 2024, 18: 1333188.
22. Li Y, Chang J, Shi G, et al. Effects of stellate ganglion block on perimenopausal hot flashes: a randomized controlled trial. Front Endocrinol (Lausanne), 2023, 14: 1293358.
23. Novy TCT. Effectiveness of ultrasound-guided stellate ganglion block in a patient with Dejerine-Roussy syndrome. Anaesth Pain Intensive Care, 2023, 27(3): 341-343.
24. Kim YS, Song JH, Kim YJ, et al. Effect of the stellate ganglion block on symptoms of ulcerative colitis: a case report. Medicine (Baltimore), 2021, 100(29): e26684.
25. Dai S, Ji J, Li R, et al. Stellate ganglion block attenuates LPS-induced acute lung injury by activating Sirt3 regulation of oxidative stress and inflammation. Biomedicines, 2024, 12(6): 1148.
26. Jeon Y. Therapeutic potential of stellate ganglion block in orofacial pain: a mini review. J Dent Anesth Pain Med, 2016, 16(3): 159-163.
27. 毕燕琳, 王彬, 尹曾, 等. 星状神经节阻滞对老龄大鼠术后海马神经元腺苷酸活化蛋白激酶和星形胶质细胞的影响. 中华医学杂志, 2014, 94(28): 2222-2226.
28. Zhang J, Liu Y, Li H, et al. Stellate ganglion block improves postoperative cognitive dysfunction in aged rats by SIRT1-mediated white matter lesion repair. Neurochem Res, 2022, 47(12): 3838-3853.
29. Kumar V. Pulmonary innate immune response determines the outcome of inflammation during pneumonia and sepsis-associated acute lung injury. Front Immunol, 2020, 11: 1722.
30. Kumar V, Chhibber S. Acute lung inflammation in Klebsiella pneumoniae B5055-induced pneumonia and sepsis in BALB/c mice: a comparative study. Inflammation, 2011, 34(5): 452-462.
31. Wang L, Yuan N, Li Y, et al. Stellate ganglion block relieves acute lung injury induced by severe acute pancreatitis via the miR-155-5p/SOCS5/JAK2/STAT3 axis. Eur J Med Res, 2022, 27(1): 231.
32. Shi Y, Li K, Xu K, et al. MiR-155-5p accelerates cerebral ischemia-reperfusion injury via targeting DUSP14 by regulating NF-κB and MAPKs signaling pathways. Eur Rev Med Pharmacol Sci, 2020, 24(3): 1408-1419.
33. Deng JJ, Zhang CL, Liu DW, et al. Treatment of stellate ganglion block in diseases: its role and application prospect. World J Clin Cases, 2023, 11(10): 2160-2167.
34. Gu Z, Xin L, Yu H, et al. Cervical sympathetic trunk transection alleviates acute lung injury caused by intestinal obstruction via inhibition of phospholipase A2 in rats. BMC Anesthesiol, 2022, 22(1): 270.
35. Liu Y, Tao T, Li W, et al. Regulating autonomic nervous system homeostasis improves pulmonary function in rabbits with acute lung injury. BMC Pulm Med, 2017, 17(1): 98.
36. Zheng X, Lv Z, Yin K, et al. Effects of epidural anesthesia combined with inhalation anesthesia or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation. Pak J Med Sci, 2018, 34(4): 799-803.
37. Ganesh A, Qadri YJ, Boortz-Marx RL, et al. Stellate ganglion blockade: an intervention for the management of ventricular arrhythmias. Curr Hypertens Rep, 2020, 22(12): 100.
38. Shahreyar M, Fahhoum R, Akinseye O, et al. Severe sepsis and cardiac arrhythmias. Ann Transl Med, 2018, 6(1): 6.
39. Ajijola OA, Hoover DB, Simerly TM, et al. Inflammation, oxidative stress, and glial cell activation characterize stellate ganglia from humans with electrical storm. JCI Insight, 2017, 2(18): e94715.
40. Meng L, Tseng CH, Shivkumar K, et al. Efficacy of stellate ganglion blockade in managing electrical storm: a systematic review. JACC Clin Electrophysiol, 2017, 3(9): 942-949.
41. Rajendran PS, Hanna P. The irate stellate ganglion: IL-6 in neuroinflammation-induced ventricular arrhythmias. Heart Rhythm, 2024, 21(5): 620-621.
42. Zhang D, Tu H, Wang C, et al. Inhibition of N-type calcium channels in cardiac sympathetic neurons attenuates ventricular arrhythmogenesis in heart failure. Cardiovasc Res, 2021, 117(1): 137-148.
43. Malik V, Shivkumar K. Stellate ganglion blockade for the management of ventricular arrhythmia storm. Eur Heart J, 2024, 45(10): 834-836.
44. Chouairi F, Rajkumar K, Benak A, et al. A multicenter study of stellate ganglion block as a temporizing treatment for refractory ventricular arrhythmias. JACC Clin Electrophysiol, 2024, 10(4): 750-758.
45. Morena A, Filippo A, Gravinese C, et al. Clinical profile of patients undergoing percutaneous stellate ganglion block for electrical storm and association with antiarrhythmic efficacy. Eur Heart J, 2024, 45(Suppl 1): ehae666.698.
46. Chouairi F, Fudim M, Benak A, et al. Factors associated with stellate ganglion block success in recurrent ventricular arrhythmias. ESC Heart Fail, 2025, 12(1): 110-117.
47. van der Pas VR, van Opstal JM, Scholten MF, et al. Percutaneous left stellate ganglion block for refractory ventricular tachycardia in structural heart disease: our single-centre experience. Neth Heart J, 2024, 32(7/8): 283-289.
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West China Medical Journal

Stellate ganglion block for sepsis-related organ dysfunction: mechanisms and clinical advances

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