Stellate Ganglion Block
What is a stellate ganglion block?
Stellate ganglion block is a short, minimally-invasive procedure that can effectively treat a wide array of conditions that have failed optimal medical management. These include providing relief for sympathetic-related pain in face, chest, and upper extremities, improving circulation in upper extremities and face, decreasing perspiration in upper extremities and face, decreasing hot flashes and associated sleep disturbances, and showing promise as a novel treatment for PTSD.
Who is a good candidate for a stellate ganglion block?
Stellate ganglion block procedures are typically used for the treatment of Complex Regional Pain Syndrome. These patients typically suffer from pain with light touch to the affected area, recurring swelling and redness of the painful area, and decreased movement in the affected area.
How a stellate ganglion block works
The stellate ganglion block can be performed in many ways. One of the most common ways to perform the stellate ganglion block is to perform it at the C6 level. Relatively large volumes (5-20 ml) are injected 2mm superficial to the C6 tubercle. This is done to spread the solution downward to reach the stellate and upper thoracic ganglia. The stellate ganglion block can also be approached from at C7 with administration of a smaller volume; however, this approach increases the risk of vertebral artery injection and collapsed lung (pneumothorax).
Posterior paravertebral approach
Another possible approach to this block is the posterior paravertebral approach. With this method, the needle is walked off the upper thoracic lamina until correct needle placement is confirmed with fluoroscopy and contrast dye. You will be asked to lie down on your back with your neck slightly extended, your head rotated slightly to the side opposite of the block, with your mouth open. Your neck will be prepped and draped in a sterile manner before local anesthesia is administered at the point of entry of the needle into the skin. After your skin is anesthetized your physician will retract your sternocleidomastoid muscle and carotid artery as his or her index and middle fingers palpate your Chassaignac’s tubercle. Your skin and subcutaneous tissue will be pressed firmly onto the tubercle to reduce the distance between the skin surface and bone. This is done to reduce the chance of pneumothorax (collapsed lung) occurring. This may be mildly uncomfortable. Upon palpating these anatomical landmarks, the needle is then advanced under fluoroscopy guidance until correct needle placement is obtained. Once position is confirmed local anesthetic is administered.
A successful block is marked by profound pain relief and improved vascular flow to ipsilateral upper extremity. Local anesthetic is usually administered for diagnostic stellate ganglion block. For patients who have a documented response to administration of local anesthetic onto the stellate ganglion, a therapeutic block can be performed with administration of a neurolytic agent, like phenol. Radioablation of the stellate ganglion is also another treatment modality for longer-lasting pain relief.
The procedure usually takes less than 15 minutes. Sometimes your physician will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor your pain and vital signs (pulse, blood pressure, temperature) after the procedure and place you in a sitting position to facilitate the spread of the anesthetic.
Are there risks?
The risks for the procedure are typically low, but can include misplacement of the needle resulting in bleeding, nerve injury, pneumothorax (collapsed lung), or esophageal perforation. Risks secondary to the spread of the anesthetic include drug allergy, seizure (if the medication is injected into a blood vessel), brachial plexus block (numb arm on side of block that lasts as long as the life of the anesthetic injected), spinal or epidural block (transient weakness and/or numbness from neck down as long as the life of the anesthetic injected), hoarseness (from anesthetizing recurrent laryngeal nerve), and shortness of breath (from anesthetizing phrenic nerve). Lastly, with any penetration of skin and soft tissues the risk of infection always exists.
The most common side effects related to the procedure are drooping of the upper eyelid, pupil constriction, and decreased sweating on the side that the block was done on, as well as voice becoming more hoarse. These side effects usually subside after the anesthetic wears off.