A Method of Treatment for Pericardial Pain

Two patients are presented, in whom dramatic, complete, and prolonged relief from the pain of acute pericarditis was afforded by left stellate ganglion block. In one, this method was successful after the patient had been virtually incapacitated by pain for 75 days. As far as we have been able to ascertain, this mode of therapy has not been previously employed. The distribution of the pain seemed to implicate the phrenic nerve; however, the relief secured by stellate ganglion block appears contrary to this traditional theory. It is concluded that the mechanism of pericardial pain is not completely understood but that the current, generally accepted explanations are quite likely inaccurate. The inferior cervical and first thoracic sympathetic ganglia may play a large, if not complete role in the transmission of these pain impulses. There are several practical aspects to our observations. Stellate ganglion block might be logically employed during the acute phase of pericarditis if the pain is severe, and also when the patient is incapacitated by recurrences. There remains also a virtually unexplored field, the relief of the pain of acute myocardial infarction by this procedure.