STELLATE GANGLION BLOCK

A stellate ganglion block has a wide array of therapeutic and diagnostic indications, including:

Pain Syndromes

Sympathetically-maintained pain syndromes
Complex Regional Pain Syndromes Type 1 and 2
Reflex sympathetic dystrophy
Shoulder/hand syndrome
Causalgia (nerve injury)
Phantom limb pain
Intractable angina
Herpetic neuralgia from herpes zoster (shingles)

Vascular Insufficiency in Upper Extremities

Arterial insufficiency
Raynaud’s phenomenon
Scleroderma

Miscellaneous

Hyperhidrosis (excessive perspiration) of the face and upper extremities
Hot flushes and sleep dysfunction related to hot flashes
Posttraumatic stress disorder (PTSD)

Anatomy:

The stellate ganglion is the ganglion formed by the fusion of the inferior cervical and the first thoracic ganglion where they meet over the vertebral body of C7 It is in close proximity to the carotid sheath, phrenic nerve, and recurrent laryngeal nerve.

Procedure:

A stellate ganglion block is an injection of local anesthetic into the sympathetic nerve tissue in the neck area. These nerves are part of the larger sympathetic nervous system and are located on both sides of the voice box. There are several methods by which the stellate ganglion block can be performed, and all of them take under one hour. Correct placement is also confirmed by administration of contrast dye. 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. A local anesthetic is usually injected to assist with the discomfort. For patients who have a documented response to administration of local anesthetic onto the stellate ganglion, a therapeutic block can be performed. Radioablation of the stellate ganglion is also another treatment for longer-lasting pain relief.

Some patients may experience symptoms from Horner’s Syndrome (drooping of the upper eyelid, pupil constriction, and decreased sweating on the side that the block was preformed). This is normal and will usually subside when the anesthetic wears of (usually ~4-6 hours after the block is preformed).

Sometimes your physician will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor your pain and vital signs for a while after the procedure and place you in a sitting position to facilitate the spread of the anesthetic.

Benefit:

Stellate ganglion block is a short, minimally invasive procedure that can effectively treat a wide array of conditions that have not responded to other treatments. These include relief for sympathetic-related facial pain, chest and upper extremity pain, circulation improvement in upper extremities and face, decreasing perspiration in upper extremities and face, decreasing hot flashes and associated sleep disturbances, and it is even showing promise as a novel treatment for PTSD.

Risk:

The risks for the procedure are typically low. As with all medical procedures, there is some risk, however. These include – misplacement of the needle resulting in: bleeding, nerve injury, pneumothorax (collapsed lung), or esophageal perforation.

There are, also, risks that can occur because of the anesthetic. These 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, as with all punctures of the skin, 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 as well as voice becoming more hoarse. These side effects usually subside after the anesthetic wears off.

Outcomes:

After the block is preformed one of three things may occur:

Your pain is gone or greatly improved and stays that way for longer than the life of the anesthetic. This shows your physician that the block has therapeutic value for you and he or she can come up with a treatment plan that maximizes your pain control
Your pain is unchanged but, there is evidence of a sympathetic blockade. This is of diagnostic value to your physician and tells him or her that your pain is not responsive to a sympathetic block and he or she can try other treatment modalities to treat your pain.
Your pain is unchanged but there is no evidence of a sympathetic blockade. This indicates that the block was a technical failure.

Stellate ganglion blocks are a well-established treatment method for providing relief from sympathetically-maintained pain syndromes. However, their benefits do not end there. Listed above, are the many of the benefits. Additionally, some people tend to have relief for weeks, while others benefit from the block for years. Fortunately, the procedure is a low risk, nonsurgical treatment that if successful the first time, will most likely continue to provide pain relief with repeat treatments. If you are suffering with pain contact Arkansas Pain today to see if you can benefit from a stellate ganglion block. We are happy to offer this exciting treatment option to patients in the Merritt Island and Melbourne area. Call today.