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We hypothesized that unilateral spinal anaesthesia would restrict the spread of hyperbaric bupivacaine to one side only (dependent side) thus sparing the opposite sympathetic chain and hence would cause less haemodynamic changes (heart rate and blood pressure) as compared to bilateral spinal anaesthesia.
However, the possibility of the tumor being malignant was one of the factors that influenced the surgeon's decision to achieve a gross-total resection even while sacrificing branches of the sympathetic chain.
Classification of Paragangliomas (Grennes and Grimley) Group Description 1 Associated with the large vessels of the chest and neck (brachial origin) 2 Associated with the vagus nerve 3 Associated with the sympathetic chain in the thoracic-lumbar region, from the aortic arch to the bladder, including the organ of Zuckerland 4 Associated with viscerae Table 2.
Trochars were inserted into the thorax in the posterior axillary line and the sympathetic chain identified.
e accessory sympathetic chain (ASC) descended anteromedial to the main sympathetic chain (MSC).
Marked ganglionitis was noted in the thoracic sympathetic chain.
Understanding the anatomy of the cervical-thoracic sympathetic chain and ganglion is key to determine whether the neural block was therapeutic and to avoid unnecessary nerve ablation procedures.
Blood supply of the human cervical sympathetic chain and ganglia.
Mode of production of analgesia is by reverse diffusion of local anaesthetic from pleural space back into subpleural space, reaching and blocking intercostal nerves, and to some extent sympathetic chain and splanchnic nerves depending on the dose and position of the patient.
To the best of our knowledge, this is a very rare report in terms of thyroid benign nodule associated with irreversible HS due to cervical sympathetic chain compression.
1,2) Schwannomas of the neck usually involve the vagus nerve or the sympathetic chain.