Stellate Ganglion Block
What is a Stellate Ganglion Block?
A Stellate ganglion block is a minimally invasive procedure that treats an array of painful conditions including pain and hypersensitivity in the face, chest, and upper extremities.
The Stellate ganglion block procedure is performed under fluoroscopy, and is performed for both diagnostic and therapeutic purposes.
The procedure seeks to determine whether or not a malfunction in the sympathetic nervous system– known as “sympathetically maintained pain” or “complex regional pain syndrome”– is the source of the patient’s pain. In that sense, it can be useful simply from a diagnostic perspective–although it quite often also produces pain relief lasting much longer than the effect of the local anesthesia. Patients suffering from sympathetically mediated pain conditions often experience hypersensitivity, swelling, discoloration or temperature changes in the involved area.
When sympathetic pain is in the upper extremity, Stellate ganglion blocks are often combined with aggressive physical therapy during the pain-free duration, in order to improve function and range of motion.
Lack of pain relief after a successfully performed Stellate ganglion block also provides us with useful information, as it essentially rules out pain due to sympathetic nervous system dysfunction.
How is a Stellate Ganglion Block done?
A local skin anesthetic is given near the base of the neck on the affected side. A needle is inserted by the Interventional Pain physician at the Stellate ganglion–a group of sympathetic nerves near the transverse process of the cervical spine (usually at the C6 level). A sterile tubing is attached to the needle and a small amount of contrast solution is injected to confirm proper placement of the needle. Following this, a solution of local anesthetic and a small dose of steroid is typically injected to “block” the ganglion.
What are the expected results?
The patient may note increased warmth and redness of the painful arm during and after the injection. The patient can expect hoarseness of their voice, redness of the eye, drooping of the eyelid and pupillary constriction for four to eight hours after the injection. These are all signs that the sympathetic nerves have been successfully blocked. If the patient does indeed suffer from sympathetically mediated pain, relief may be noted immediately. Duration of relief is variable. The patient must assess their pain relief over the first three to four hours after the injection and report this to the physician.