Atypical chest pain treated with stellate ganglion blocks

A 67 year old gentleman was seen in the Pain Clinic complaining of chest pains 5-6/10. He had previously had 6 cardiac bypass procedures as he had had unstable angina.

Unfortunately, approximately 6-8 months after his bypass procedures, he started getting pain in the chest which he had previously suffered before the bypasses. Unfortunately, he was not a candidate for further surgery and he was sent to the Pain Clinic for pain relief. The pain went across the left anterior part of his chest, was aggravated by exercise and walking and relieved by rest, and was associated with shortness of breath.

Drug History: Aspirin, Glycerol Trinitrate, Atenolol, Perindopril, Amlodipine, Nicorandil, Atorvastatin and Isosorbide Mononitrate.

On examination, he had a mid-line sternotomy scar in the middle of his chest. He had tender points at the left lateral part of the chest but otherwise his examination was unremarkable. A diagnosis of intractable cardiac chest pain refractory to cardiac bypass surgery was made. One of the treatments for this in the absence of benefit from medication is to use stellate ganglion blocks in order to chemically reduce his sympathetic activity. This gentleman had a course of 6 stellate ganglion blocks done at approximately 1-2 weekly intervals.

Two months after the end of his last stellate ganglion block, he was seen in the clinic. He felt that he had greatly benefited from his treatment and his average pain score was now 0/10, with a worst pain score of 4/10 but this only came intermittently. He felt that the most severe pain symptoms; feeling as if he had been “punched in the chest” had now disappeared. He was only taking Co-dydramol. This gentleman opted to have a repeat of the 6 stellate ganglion nerve blocks to see if he could get even greater pain relief.