Araştırma Makalesi
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Sympathetic Ganglion Blocks in the Elderly: Efficacy, Safety, Analgesic Consumption, and Complications

Yıl 2026, Cilt: 16 Sayı: 1, 96 - 102, 19.03.2026
https://izlik.org/JA98JZ22UN

Öz

Aim: Chronic pain management is crucial in geriatric pain management.
Sympathetic ganglion blocks are minimally invasive procedures
performed in pain conditions associated with the sympathetic
system, such as cancer-related, ischemic, and neuropathic
pain. Data regarding the effectiveness and safety of these blocks
in elderly patients are limited. This study evaluates the effects of
sympathetic ganglion blocks on pain intensity, opioid consumption,
and complications.
Materials and Methods: This retrospective cohort study included
417 patients aged ≥65 years who underwent a sympathetic ganglion
block. Procedures included stellate, thoracic and lumbar
sympathetic, celiac, splanchnic, hypogastric, and impar ganglion
blocks. Pain intensity was assessed using the Visual Analog Scale
(VAS), and opioid use was converted to morphine equivalents.
Complications were classified as minor or major.
Results: Visual analog scale scores significantly decreased from
7.88±0.89 at baseline to 3.98±1.30 at 1 month and 5.76±1.51
at 3 months (p <0.001). Daily opioid consumption was reduced
from 90.38±99.45 mg/day to 36.39±33.36 mg/day at 3 months
(p <0.001), with the most pronounced decrease in malignant patients.
Complications were observed in 35% of patients, primarily
minor (e.g., orthostatic hypotension, Horner syndrome), while major
complications were rare (e.g., pneumothorax).
Conclusion: Sympathetic ganglion blocks effectively reduce pain
and opioid use in elderly patients with chronic pain of malignant
and nonmalignant origins. Although complication rates are noteworthy,
safety can be ensured with careful patient selection and
follow-up.

Kaynakça

  • 1. Kong F. Aging trend of the world. In: Hoshi T, Kodama S, editors. The structure of healthy life determinants. Vol 18. International perspectives on aging. Cham: Springer; 2018. p. 15-28.
  • 2. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331–1346. https://doi.org/10.1111/j.1532-5415.2009.02376.x
  • 3. Borsheski R, Johnson QL. Pain management in the geriatric population. Mo Med. 2014;111(6):508–511.
  • 4. Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med. 2001;17(3):417–431. https://doi.org/10.1016/S0749-0690(05)70078-1
  • 5. Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, et al. Guidance on the management of pain in older people. Age Ageing. 2013;42 Suppl 1:i1-i57. https://doi.org/10.1093/ ageing/afs200
  • 6. Rastogi R, Meek BD. Management of chronic pain in elderly, frail patients: finding a suitable, personalized method of control. Clin Interv Aging. 2013;8:37–46. https://doi.org/10.2147/ CIA.S30165
  • 7. Tetzlaff JE. Cousins and Bridenbaugh’s neural blockade in clinical anesthesia and pain medicine. Mayo Clin Proc. 2010;85(7):e51. https://doi.org/10.4065/mcp.2010.0230
  • 8. Gunduz OH, Kenis-Coskun O. Ganglion blocks as a treatment of pain: current perspectives. J Pain Res. 2017;10:2815–2826.https://doi.org/10.2147/JPR.S134775
  • 9. Mercadante S, Klepstad P, Kurita GP, Sjøgren P, Giarratano A; European Palliative Care Research Collaborative (EPCRC). Sympathetic blocks for visceral cancer pain management: a systematic review and EAPC recommendations. Crit Rev Oncol Hematol. 2015;96(3):577–583. https://doi.org/10.1016/j.critrevonc.2015.07.014
  • 10. Nie Y, Song R, Chen W, Qin Z, Zhang J, Tang J. Effects of stellate ganglion block on cerebrovascular vasodilation in elderly patients and patients with subarachnoid haemorrhage. Br J Anaesth. 2016;117(1):131–132. https://doi.org/10.1093/bja/aew157
  • 11. Chen YQ, Jin XJ, Liu ZF, Zhu MF. Effects of stellate ganglion block on cardiovascular reaction and heart rate variability in elderly patients during anesthesia induction and endotracheal intubation. J Clin Anesth. 2015;27(2):140–145. https://doi.org/10.1016/j.jclinane.2014.06.012
  • 12. Khosla A, Adeyefa O, Nasir S. Successful treatment of radiationinduced proctitis pain by blockade of the ganglion impar in an elderly patient with prostate cancer: a case report. Pain Med.2013;14(5):662–666. https://doi.org/10.1111/pme.12065
  • 13. Higuera O, Ghanem I, Nasimi R, Prieto I, Koren L, Feliu J. Management of pancreatic cancer in the elderly. World J Gastroenterol. 2016;22(2):764–775. https://doi.org/10.3748/ wjg.v22.i2.764
  • 14. Souter KJ, Fitzgibbon D. Equianalgesic dose guidelines for long-term opioid use -theoretical and practical considerations. Semin Anesth. 2004;23:271–280. https://doi.org/10.1053/j. sane.2004.06.001
  • 15. Deer TR, Pope JE, Lamer TJ, Provenzano D, editors. Deer’s treatment of pain: an illustrated guide for practitioners. Cham:Springer; 2019. https://doi.org/10.1007/978-3-030-12281-2
  • 16. Christiansen S, Erdek M. Neurolytic sympathetic blocks. In:Barash PG, Cullen BF, Stoelting RK, et al., editors. Handbook of pain management. Philadelphia: Elsevier; 2018. p. 321-335. https://doi.org/10.1016/B978-0-323-40196-8.00071-1
  • 17. Bedran H. Neurolytic agents: mechanism and usage in pain medicine. In: Collantes Celador E, Rudiger J, Tameem A, editors. Oxford handbook of anesthesia. Oxford: Oxford University Press; 2022. p. 112-118. https://doi.org/10.1093/med/9780198799443.003.0011
  • 18. Abd-Elsayed A, Rushmer T. Neurolytic and nonneurolyticblocks in pain management. In: Abd-Elsayed A, editor. Advanced anesthesia review. New York: Oxford University Press; 2023. p. 215-228.
  • 19. Phuphanich ME, Convery QW, Nanda UK, Pangarkar S. Sympathetic blocks for sympathetic pain. Phys Med Rehabil Clin N Am. 2022;33(3):465–480. https://doi.org/10.1016/j. pmr.2022.02.002
  • 20. Vorenkamp K, Yi P, Kemp A. Sympathetic blocks for visceral pain. Phys Med Rehabil Clin N Am. 2022;33(2):475–487. https://doi.org/10.1016/j.pmr.2022.01.010
  • 21. Kwon HJ, Jang K, Leem JG, Shin JW, Kim DH, Choi SS. Factors associated with successful response to neurolytic celiac plexus block in patients with upper abdominal cancer-related pain: a retrospective study. Korean J Pain. 2021;34(4):479–486. https://doi.org/10.3344/kjp.2021.34.4.479
  • 22. Liou H, Kong MJ, Alzubaidi S, Knuttinen MG, Patel IJ, Kriegshauser JS. Single-center review of celiac plexus/retrocrural splanchnic nerve block for non-cancer related pain. Acad Radiol. 2021;28(5):623–630. https://doi.org/10.1016/j.acra.2021.03.005
  • 23. Aleanakian R, Chung BY, Feldmann RE, Benrath J. Effectiveness, safety, and predictive potential in ultrasound-guided stellate ganglion blockades for the treatment of sympathetically maintained pain. Pain Pract. 2020;20(5):570–578. https://doi.org/10.1111/papr.12892
  • 24. Wi Y, Laksono RM, Asmoro AA, Isngadi I, Laksono BH, Jaya W. Pain management with ganglion impar block in adenocarcinoma recti. Solo J Anesthesiol Pain Crit Care. 2024;4(1):689–696.https://doi.org/10.20961/soja.v4i1.68927
  • 25. Persico AL, Wegrzyn EL. Geriatric pain pharmacotherapy. In: Herndon CM, editor. Pain. Oxford: Oxford University Press; 2022. p. 399-406. https://doi.org/10.1093/med/9780197542873.003.0046
  • 26. Smith HS, Bruckenthal P. Implications of opioid analgesia for medically complicated patients. Drugs Aging. 2010;27(5):417–433. https://doi.org/10.2165/11536540-000000000-00000
  • 27. Dhanani NM, Almonte WA, Engle MP. Sympathetic nervous system blocks for the treatment of cancer pain. In: Handbook of cancer pain management. Cham: Springer; 2019. p. 243-260.https://doi.org/10.1007/978-3-319-99684-4_17
  • 28. Murphy PA, Kreling B, Kathryn E, Stevens M, Lynn J, Dulac JD. Description of the SUPPORT intervention. J Am Geriatr Soc. 2000;48(5 Suppl):S120-S125. https://doi.org/10.1111/j.1532-5415.2000.tb03125.x
  • 29. Kim E, Lim JA, Choi CH, Lee SY, Kwak S, Kim J. Assessment of the changes in cardiac sympathetic nervous activity using pupil size changes measured in seated patients whose stellate ganglion is blocked by interscalene brachial plexus block. Korean J Anesthesiol. 2023;76(2):116–127. https://doi.org/10.4097/kja.22324
  • 30. Gupta R, Madanat L, Jindal V, Gaikazian S. Celiac plexus block complications: a case report and review of the literature. J Palliat Med. 2021;24(1):45–50. https://doi.org/10.1089/ jpm.2020.0530

Yıl 2026, Cilt: 16 Sayı: 1, 96 - 102, 19.03.2026
https://izlik.org/JA98JZ22UN

Öz

Kaynakça

  • 1. Kong F. Aging trend of the world. In: Hoshi T, Kodama S, editors. The structure of healthy life determinants. Vol 18. International perspectives on aging. Cham: Springer; 2018. p. 15-28.
  • 2. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331–1346. https://doi.org/10.1111/j.1532-5415.2009.02376.x
  • 3. Borsheski R, Johnson QL. Pain management in the geriatric population. Mo Med. 2014;111(6):508–511.
  • 4. Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med. 2001;17(3):417–431. https://doi.org/10.1016/S0749-0690(05)70078-1
  • 5. Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, et al. Guidance on the management of pain in older people. Age Ageing. 2013;42 Suppl 1:i1-i57. https://doi.org/10.1093/ ageing/afs200
  • 6. Rastogi R, Meek BD. Management of chronic pain in elderly, frail patients: finding a suitable, personalized method of control. Clin Interv Aging. 2013;8:37–46. https://doi.org/10.2147/ CIA.S30165
  • 7. Tetzlaff JE. Cousins and Bridenbaugh’s neural blockade in clinical anesthesia and pain medicine. Mayo Clin Proc. 2010;85(7):e51. https://doi.org/10.4065/mcp.2010.0230
  • 8. Gunduz OH, Kenis-Coskun O. Ganglion blocks as a treatment of pain: current perspectives. J Pain Res. 2017;10:2815–2826.https://doi.org/10.2147/JPR.S134775
  • 9. Mercadante S, Klepstad P, Kurita GP, Sjøgren P, Giarratano A; European Palliative Care Research Collaborative (EPCRC). Sympathetic blocks for visceral cancer pain management: a systematic review and EAPC recommendations. Crit Rev Oncol Hematol. 2015;96(3):577–583. https://doi.org/10.1016/j.critrevonc.2015.07.014
  • 10. Nie Y, Song R, Chen W, Qin Z, Zhang J, Tang J. Effects of stellate ganglion block on cerebrovascular vasodilation in elderly patients and patients with subarachnoid haemorrhage. Br J Anaesth. 2016;117(1):131–132. https://doi.org/10.1093/bja/aew157
  • 11. Chen YQ, Jin XJ, Liu ZF, Zhu MF. Effects of stellate ganglion block on cardiovascular reaction and heart rate variability in elderly patients during anesthesia induction and endotracheal intubation. J Clin Anesth. 2015;27(2):140–145. https://doi.org/10.1016/j.jclinane.2014.06.012
  • 12. Khosla A, Adeyefa O, Nasir S. Successful treatment of radiationinduced proctitis pain by blockade of the ganglion impar in an elderly patient with prostate cancer: a case report. Pain Med.2013;14(5):662–666. https://doi.org/10.1111/pme.12065
  • 13. Higuera O, Ghanem I, Nasimi R, Prieto I, Koren L, Feliu J. Management of pancreatic cancer in the elderly. World J Gastroenterol. 2016;22(2):764–775. https://doi.org/10.3748/ wjg.v22.i2.764
  • 14. Souter KJ, Fitzgibbon D. Equianalgesic dose guidelines for long-term opioid use -theoretical and practical considerations. Semin Anesth. 2004;23:271–280. https://doi.org/10.1053/j. sane.2004.06.001
  • 15. Deer TR, Pope JE, Lamer TJ, Provenzano D, editors. Deer’s treatment of pain: an illustrated guide for practitioners. Cham:Springer; 2019. https://doi.org/10.1007/978-3-030-12281-2
  • 16. Christiansen S, Erdek M. Neurolytic sympathetic blocks. In:Barash PG, Cullen BF, Stoelting RK, et al., editors. Handbook of pain management. Philadelphia: Elsevier; 2018. p. 321-335. https://doi.org/10.1016/B978-0-323-40196-8.00071-1
  • 17. Bedran H. Neurolytic agents: mechanism and usage in pain medicine. In: Collantes Celador E, Rudiger J, Tameem A, editors. Oxford handbook of anesthesia. Oxford: Oxford University Press; 2022. p. 112-118. https://doi.org/10.1093/med/9780198799443.003.0011
  • 18. Abd-Elsayed A, Rushmer T. Neurolytic and nonneurolyticblocks in pain management. In: Abd-Elsayed A, editor. Advanced anesthesia review. New York: Oxford University Press; 2023. p. 215-228.
  • 19. Phuphanich ME, Convery QW, Nanda UK, Pangarkar S. Sympathetic blocks for sympathetic pain. Phys Med Rehabil Clin N Am. 2022;33(3):465–480. https://doi.org/10.1016/j. pmr.2022.02.002
  • 20. Vorenkamp K, Yi P, Kemp A. Sympathetic blocks for visceral pain. Phys Med Rehabil Clin N Am. 2022;33(2):475–487. https://doi.org/10.1016/j.pmr.2022.01.010
  • 21. Kwon HJ, Jang K, Leem JG, Shin JW, Kim DH, Choi SS. Factors associated with successful response to neurolytic celiac plexus block in patients with upper abdominal cancer-related pain: a retrospective study. Korean J Pain. 2021;34(4):479–486. https://doi.org/10.3344/kjp.2021.34.4.479
  • 22. Liou H, Kong MJ, Alzubaidi S, Knuttinen MG, Patel IJ, Kriegshauser JS. Single-center review of celiac plexus/retrocrural splanchnic nerve block for non-cancer related pain. Acad Radiol. 2021;28(5):623–630. https://doi.org/10.1016/j.acra.2021.03.005
  • 23. Aleanakian R, Chung BY, Feldmann RE, Benrath J. Effectiveness, safety, and predictive potential in ultrasound-guided stellate ganglion blockades for the treatment of sympathetically maintained pain. Pain Pract. 2020;20(5):570–578. https://doi.org/10.1111/papr.12892
  • 24. Wi Y, Laksono RM, Asmoro AA, Isngadi I, Laksono BH, Jaya W. Pain management with ganglion impar block in adenocarcinoma recti. Solo J Anesthesiol Pain Crit Care. 2024;4(1):689–696.https://doi.org/10.20961/soja.v4i1.68927
  • 25. Persico AL, Wegrzyn EL. Geriatric pain pharmacotherapy. In: Herndon CM, editor. Pain. Oxford: Oxford University Press; 2022. p. 399-406. https://doi.org/10.1093/med/9780197542873.003.0046
  • 26. Smith HS, Bruckenthal P. Implications of opioid analgesia for medically complicated patients. Drugs Aging. 2010;27(5):417–433. https://doi.org/10.2165/11536540-000000000-00000
  • 27. Dhanani NM, Almonte WA, Engle MP. Sympathetic nervous system blocks for the treatment of cancer pain. In: Handbook of cancer pain management. Cham: Springer; 2019. p. 243-260.https://doi.org/10.1007/978-3-319-99684-4_17
  • 28. Murphy PA, Kreling B, Kathryn E, Stevens M, Lynn J, Dulac JD. Description of the SUPPORT intervention. J Am Geriatr Soc. 2000;48(5 Suppl):S120-S125. https://doi.org/10.1111/j.1532-5415.2000.tb03125.x
  • 29. Kim E, Lim JA, Choi CH, Lee SY, Kwak S, Kim J. Assessment of the changes in cardiac sympathetic nervous activity using pupil size changes measured in seated patients whose stellate ganglion is blocked by interscalene brachial plexus block. Korean J Anesthesiol. 2023;76(2):116–127. https://doi.org/10.4097/kja.22324
  • 30. Gupta R, Madanat L, Jindal V, Gaikazian S. Celiac plexus block complications: a case report and review of the literature. J Palliat Med. 2021;24(1):45–50. https://doi.org/10.1089/ jpm.2020.0530
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Anesteziyoloji
Bölüm Araştırma Makalesi
Yazarlar

Ahmet Başarı

Hanzade Aybüke Ünal-Özer

Güngör Enver Özgencil

İbrahim Aşık

Gönderilme Tarihi 19 Haziran 2025
Kabul Tarihi 10 Şubat 2026
Yayımlanma Tarihi 19 Mart 2026
IZ https://izlik.org/JA98JZ22UN
Yayımlandığı Sayı Yıl 2026 Cilt: 16 Sayı: 1

Kaynak Göster

APA Başarı, A., Ünal-Özer, H. A., Özgencil, G. E., & Aşık, İ. (2026). Sympathetic Ganglion Blocks in the Elderly: Efficacy, Safety, Analgesic Consumption, and Complications. Kafkas Journal of Medical Sciences, 16(1), 96-102. https://izlik.org/JA98JZ22UN
AMA 1.Başarı A, Ünal-Özer HA, Özgencil GE, Aşık İ. Sympathetic Ganglion Blocks in the Elderly: Efficacy, Safety, Analgesic Consumption, and Complications. KAFKAS TIP BİL DERG. 2026;16(1):96-102. https://izlik.org/JA98JZ22UN
Chicago Başarı, Ahmet, Hanzade Aybüke Ünal-Özer, Güngör Enver Özgencil, ve İbrahim Aşık. 2026. “Sympathetic Ganglion Blocks in the Elderly: Efficacy, Safety, Analgesic Consumption, and Complications”. Kafkas Journal of Medical Sciences 16 (1): 96-102. https://izlik.org/JA98JZ22UN.
EndNote Başarı A, Ünal-Özer HA, Özgencil GE, Aşık İ (01 Mart 2026) Sympathetic Ganglion Blocks in the Elderly: Efficacy, Safety, Analgesic Consumption, and Complications. Kafkas Journal of Medical Sciences 16 1 96–102.
IEEE [1]A. Başarı, H. A. Ünal-Özer, G. E. Özgencil, ve İ. Aşık, “Sympathetic Ganglion Blocks in the Elderly: Efficacy, Safety, Analgesic Consumption, and Complications”, KAFKAS TIP BİL DERG, c. 16, sy 1, ss. 96–102, Mar. 2026, [çevrimiçi]. Erişim adresi: https://izlik.org/JA98JZ22UN
ISNAD Başarı, Ahmet - Ünal-Özer, Hanzade Aybüke - Özgencil, Güngör Enver - Aşık, İbrahim. “Sympathetic Ganglion Blocks in the Elderly: Efficacy, Safety, Analgesic Consumption, and Complications”. Kafkas Journal of Medical Sciences 16/1 (01 Mart 2026): 96-102. https://izlik.org/JA98JZ22UN.
JAMA 1.Başarı A, Ünal-Özer HA, Özgencil GE, Aşık İ. Sympathetic Ganglion Blocks in the Elderly: Efficacy, Safety, Analgesic Consumption, and Complications. KAFKAS TIP BİL DERG. 2026;16:96–102.
MLA Başarı, Ahmet, vd. “Sympathetic Ganglion Blocks in the Elderly: Efficacy, Safety, Analgesic Consumption, and Complications”. Kafkas Journal of Medical Sciences, c. 16, sy 1, Mart 2026, ss. 96-102, https://izlik.org/JA98JZ22UN.
Vancouver 1.Ahmet Başarı, Hanzade Aybüke Ünal-Özer, Güngör Enver Özgencil, İbrahim Aşık. Sympathetic Ganglion Blocks in the Elderly: Efficacy, Safety, Analgesic Consumption, and Complications. KAFKAS TIP BİL DERG [Internet]. 01 Mart 2026;16(1):96-102. Erişim adresi: https://izlik.org/JA98JZ22UN